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Preventive Antibiotics for Stable COPD: What’s the Evidence?

Given that bacterial respiratory tract infections can trigger exacerbations of chronic obstructive pulmonary disease (COPD), it seems logical that prophylactic antibiotics may benefit patients with COPD. But conflicting evidence about their risk-to-benefit ratio prompted investigators to systematically evaluate the data.
After analyzing 12 randomized controlled trials (RCTs) enrolling a total of 3683 patients with stable, moderate to severe COPD, the researchers concluded that antibiotic therapy effectively prevented COPD exacerbations and improved quality of life.
The RCTs included in the systematic review were azithromycin, erythromycin, moxifloxacin, clarithromycin, roxithromycin, and doxycycline. The duration and dosage schedule of the antibiotics were considered in subgroup analyses.
“Prophylactic antibiotics significantly reduced the frequency of exacerbations … and the number of patients with one or more exacerbations … . Erythromycin and azithromycin appeared the most effective,” the authors wrote.
They noted that the choice of prophylactic antibiotics should be considered individually in each case, especially for long and continuous use.

REFERENCE:
Wang Y, Zijp TR, Bahar MA, Kocks JWH, Hak E. Effects of prophylactic antibiotics on patients with stable COPD: a systematic review and meta-analysis of randomized controlled trials [published online September 4, 2018]. J Antimicrob Chemother. https://doi.org/10.1093/jac/dky326.

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