AECOPD outcomes unaltered with short-course nonmacrolide therapy

Short-course nonmacrolide therapy in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) appears to have no significant effect on outcomes including mortality, progression to ventilation, readmission rate, and prevalence of adverse drug events, a study has shown.

Researchers looked at the medical records of 135 culture-negative critically ill adults admitted to an intensive care unit (ICU) for AECOPD. The patients had received treatment with an empiric corticosteroid, azithromycin, and/or a nonmacrolide antibiotic.

Of the patients, 66 received short-course nonmacrolide therapy (≤3 days) while 69 were given standard-course therapy (>3 days). These two groups were compared in terms of in-hospital mortality, progression to the need for ventilation, and/or readmission for AECOPD within 30 days (primary composite endpoint). Additional endpoints included hospital and ICU lengths of stay (LOS), all-cause 30-day readmission, and prevalence of antibiotic-related adverse events.

The incidence of the primary composite endpoint was only borderline lower with the short-course than with the standard-course nonmacrolide therapy (24.2 percent vs 39.1 percent; p=0.06). Likewise, there was no significant difference in the primary composite endpoint’s individual components.

However, the short-course treatment led to a much shorter median ICU LOS (2 vs 3 days) and hospital LOS (4 vs 6 days) compared with the standard-course group (p<0.01).

Multivariate logistic regression confirmed no association between treatment assignment and the primary endpoint.

More studies with larger populations are needed to validate the present findings.