Do Antibiotics Improve Patient Outcomes in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Authors included 19 randomized controlled trials (11 outpatient, 7 inpatient, and 1 ICU) comprising 2,663 patients. Sample sizes ranged from 19 to 310 patients. Studies used amoxicillin-clavulanic acid, trimethoprim/sulfamethoxazole, doxycycline, levofloxacin, ciprofloxacin, piperacillin-sulbactam, amoxicillin, and penicillin, as well as several drugs not commonly used, such as oxytetracycline, tetracycline hydrochloride, cotrimoxazole, ofloxacin, chloramphenicol, streptomycin, and cefaclor. Low-quality evidence suggested current antibiotics reduced risk of treatment failure for patients with mild to moderate exacerbation who were treated as outpatients, with an absolute reduction approaching 8.3% (Table). Antibiotics for inpatients did not display statistically significant results, but trends suggested benefit in treatment failure (11% absolute reduction).

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