The problems of meta-analysis for antibiotic treatment of chronic obstructive pulmonary disease, a heterogeneous disease: a commentary on Puhan et al.
Exacerbations are a major cause of morbidity and mortality in chronic obstructive pulmonary disease. Exacerbations can be of bacterial, viral or mixed etiology, with bacteria involved in 50% of exacerbations. Consequently, current management of exacerbations frequently involves the use of antibiotics. The paper by Puhan et al published this month in BMC Medicine examines the benefit of antibiotics in placebo-controlled trials in mild to moderate outpatient exacerbations. The authors use a meta-analytic approach and rightly conclude that more trials are needed in this area. However, the heterogeneity of chronic obstructive pulmonary disease patients and exacerbations and the limited end-points in past trials do not allow firm conclusions to be drawn about antibiotic use in outpatient exacerbations based on this meta-analysis. Future trials need to take into account this heterogeneity as well as incorporate novel end-points to address this important issue.
Sethi
Sanjay
S
Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York and VA Western New York Healthcare System, Buffalo, New York, USA. ssethi@buffalo.edu
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
D000900:Anti-Bacterial Agents