Role of antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease.
OBJECTIVE
To define the role of antimicrobial therapy in the treatment of acute bronchitic exacerbations of chronic obstructive pulmonary disease (COPD) through review of placebo-controlled clinical trials. Specificalty, to determine the benefit of antimicrobial therapy on patient outcome.


METHODS
Placebo-controlled dinical trials identified by MEDLINE search (1957-December 1999).


METHODS
All placebo-controlled clinical trials that included COPD patients with no evidence of pneumonia or underlying asthma were included in the evaluation.


RESULTS
The role of antimicrobial agents in the treatment of acute exacerbations of COPD is controversial. Patients with COPD are often chronically colonized with bacteria, and many exacerbations are due to nonbacterial causes. Four placebo-controlled clinical trials and a meta-analysis have demonstrated significant improvements in outcome for patients treated with an antibiotic versus placebo. In contrast, six studies failed to demonstrate statistical differences, possibly due to the small sample size and the subjectivity of outcome measures. Overall, the data suggest that the benefit of antimicrobial therapy in acute exacerbations of COPD may be related to exacerbation severity.


CONCLUSIONS
Antimicrobial agents may have a beneficial effect in the treatment of acute exacerbations of COPD in certain patients. Pending further research in this area, we recommend antimicrobial therapy only for COPD patients with acute bronchitic exacerbations characterized by increased dyspnea, sputum volume, and purulence.
Russo
R L
RL
Infectious Disease, College of Pharmacy, Rutgers, The State University of New Jersey, Piscataway 08854-8022, USA.
D'Aprile
M
M
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D013183:Sputum / Q000382:microbiology
D000900:Anti-Bacterial Agents