Are antibiotics beneficial for flare-ups of COPDs? #Cochrane
Flare-ups of COPD are a hallmark of more advanced stages of the disease. Flare-ups are defined as sustained worsening of symptoms from the patient's usual stable state. Commonly reported symptoms include worsening breathlessness, cough, increased sputum production, and change in sputum colour. Clinicians frequently prescribe antibiotics for flare-ups in patients with COPD, although the cause of flare-ups is often difficult to determine (viral, bacterial, environmental).

The present systematic review evaluated if the benefits of taking antibiotics for flare-ups of COPD outweigh potential harms (e.g. risks of multi-resistant bacteria for this population).

The authors assessed effects of antibiotics on treatment failure as observed between seven days and one month after treatment initiation (primary outcome) for management of acute COPD exacerbations, as well as their effects on other patient-important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation).

Analyses showed that currently used antibiotics reduced treatment failures (no improvement in symptoms, despite treatment, within 7 to 28 days, depending on the study) compared with placebo in outpatients with mild to moderate flare-ups, as well as in patients admitted to an intensive care unit for very severe flare-ups with respiratory failure. However, antibiotics did not reduce treatment failures among hospitalised patients with severe flare-ups

Although trial results show that antibiotics were effective across outcomes for patients with very severe flare-ups and respiratory failure who needed treatment in an intensive care unit, researchers report inconsistent effects in patients with mild to severe flare-ups. Future high-quality studies should examine clinical signs or blood tests at the time of presentation that are useful for identifying patients who can benefit from antibiotic therapy.

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