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Are prophylactic antibiotics useful in chronic obstructive pulmonary disease?

Alex Arenas1, Gabriel Rada2

  • 1Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile.

Medwave
|November 17, 2015
PubMed

Insights

Prophylactic antibiotics likely reduce exacerbations in chronic obstructive pulmonary disease (COPD). However, this antibiotic use shows no significant impact on COPD hospitalizations or mortality rates.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Pharmacology

Background:

  • Bacterial infections are a primary trigger for chronic obstructive pulmonary disease (COPD) exacerbations.
  • Prophylactic antibiotic use, particularly macrolides, is considered for COPD patients.
  • The risk-benefit balance and cost-effectiveness of prophylactic antibiotics in COPD remain uncertain.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic antibiotics in reducing exacerbations, hospitalizations, and mortality in patients with chronic obstructive pulmonary disease (COPD).

Main Methods:

  • A comprehensive search of the Epistemonikos database, screening 30 sources, identified five systematic reviews encompassing eight randomized controlled trials.
  • Evidence from these trials was synthesized using meta-analysis.
  • A summary of findings table was created adhering to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach.

Main Results:

  • Prophylactic antibiotic administration was associated with a probable decrease in the frequency of COPD exacerbations.
  • No significant effect was observed on the rates of hospitalization due to COPD exacerbations.
  • Mortality rates in the prophylactic antibiotic group were not significantly different compared to the control group.

Conclusions:

  • Prophylactic antibiotics may be beneficial in decreasing the occurrence of exacerbations in patients with chronic obstructive pulmonary disease (COPD).
  • Current evidence suggests that prophylactic antibiotics do not reduce hospitalizations or mortality associated with COPD.

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