Does Antibiotic Administration During Acute Exacerbations of COPD Result in
Improved Outcomes?
Clinical Question
See title above.
Clinical Bottom Lines
- Antibiotic therapy during acute exacerbations of COPD results in a small
but statistically significant improvement in combined outcome measures, and
should be considered standard treatment in all patients with COPD exacerbations.
See comments below
The Evidence
- An effect size was
calculated for each study in order to compare the different outcome variables.
- Effect size was positive in 7 studies, and negative in 2.
|
Effect Size (95% CI) |
| Overall |
0.22 (0.10 - 0.34) |
- OUTCOME MEASURES:
- days of illness
- overall symptom score
- change in Peak Expiratory Flow Rate
- Final PaO2
- various combinations of the above measures
Comments
- This was a meta-analysis of several RCTs.
- Data analysis was rigorous, and is valid on all counts according to the
JAMA guidelines.
- Effect Sizes were summarized across the nine studies and each was given
weight according to the inverse of the
variance.
- Tests of heterogeneity did not reach statistical significance for any ES
or outcome measure, and each individual comparison with the overall ES was not
statistically significant.
This reviewer finds the results of this study to be both believable and
applicable, and antibiotics should be prescribed for all patients with COPD
exacerbations.
APPRAISED BY: Steven Simon, MD
DATE: October 13, 1995
Sanjay S, et al. Antibiotics in Chronic Obstructive Pulmonary
Disease Exacerbations: A Meta-analysis. JAMA 1995;273(12):957-960.
