Antibiotics, corticosteroids reduce treatment failure in adults with COPD exacerbation

Use of antibiotics and systemic corticosteroids can help decrease treatment failure in adults with mild-to-severe exacerbation of chronic obstructive pulmonary disease (COPD), results of a systematic review and meta-analysis have shown.

The investigators performed English-language searches of several bibliographic sources from database inception through 2 January 2019 and were able to identify 68 randomized controlled trials. Included studies enrolled adults with COPD exacerbation treated in out- or inpatient settings other than intensive care and compared pharmacologic therapies with placebo, usual care or other interventions. In addition, two independent reviewers extracted data and rated study quality and strength of evidence (SOE).

Treatment with antibiotics for 3–14 days, compared with placebo or management without antibiotics, led to increased resolution of COPD exacerbation (odds ratio [OR], 2.03, 95 percent confidence interval [CI], 1.47–2.80; moderate SOE) and less treatment failure at the end of intervention (OR, 0.54, 95 percent CI, 0.34–0.86; moderate SOE), independent of severity of exacerbation in out- and inpatients.

In addition, systemic corticosteroids given for 9–56 days, compared with placebo, in out- and inpatients also resulted in less treatment failure at the end of intervention (OR, 0.01, 95 percent CI, 0.00–0.13; low SOE) but was associated with a higher number of total and endocrine-related adverse events (AEs).

On the other hand, there were insufficient evidence for other pharmacologic intervention (eg, aminophyllines, magnesium sulfate, anti-inflammatory agents, inhaled corticosteroids and short-acting bronchodilators), compared with placebo or usual care, in inpatients, showing either no or inconclusive effects (except for mucolytic erdosteine) or improvement only in lung function.

The study was limited by scant evidence for many interventions, and several trials had unclear or high risk of bias and inadequate reporting of AEs, according to the investigators.