Antibiotics for Acute Exacerbations in COPD: Comparison of Effectiveness and Tolerability

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Of all the antibiotics compared for the treatment of acute exacerbations in COPD, dirithromycin had a high clinical cure rate with a low adverse effect rate.
Of all the antibiotics compared for the treatment of acute exacerbations in COPD, dirithromycin had a high clinical cure rate with a low adverse effect rate.

A recent meta-analysis published in BMC Pulmonary Medicine found that dirithromycin had a high clinical cure rate with a low adverse effect rate in patients with acute exacerbations from chronic obstructive pulmonary disease (COPD); ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole also had high clinical cure rates, but median rates of adverse effects.

The authors searched the PubMed, EmBase, and Cochrane databases for randomized controlled trials published up to September 2016 that evaluated the use of antibiotics for the treatment of acute exacerbations of COPD.

Primary study end points were clinical cure rates and adverse effects; microbiological response rate, relapse of exacerbation, and mortality were analyzed as well. The researchers used a random-effect network to assess the effectiveness and tolerability of each antibiotic used in acute exacerbations of COPD.

The authors included 19 articles assessing 17 antibiotics used in 5906 patients with acute exacerbations of COPD. Cluster ranking demonstrated that dirithromycin had high clinical cure rates with a low rate of adverse effects. Ranking the treatments based on surface under the cumulative ranking probability scores, the authors noted that in terms of efficacy, ofloxacin (79.1%) was the most likely to be the best antibiotic for treating acute exacerbations of COPD, followed by ciprofloxacin (70.4%) and trimethoprim-sulfamethoxazole (68.1%). In terms of tolerability, dirithromycin (88.4%) was most likely to be the best drug, followed by azithromycin (81.4%) and amoxicillin (68.6%).

The authors performed traditional meta-analysis for microbiological response rate, frequency of recurrence, and mortality. Only the microbiological response rate of doxycycline was significantly better than placebo (odds ratio, 3.84; 95% CI, 1.96-7.54; P <.001). No significant results were found for frequency of recurrence or mortality rates.

The authors concluded that this network meta-analysis provided a more comprehensive understanding of the efficacy and tolerability of the antibiotics and allowed for indirect comparison of the drugs. However, they advised caution in using antibiotics to treat exacerbations of COPD, as adverse effects occur with all of these drugs.

Reference

Zhang H-L, Tan M, Qiu A-M, Tao Z, Wang C-H. Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis. BMC Pulm Med. 2017;17(1):196.

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