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Does antibiotic treatment duration affect the outcomes of exacerbations of asthma and COPD? A systematic review.
- Source :
-
Chronic respiratory disease [Chron Respir Dis] 2018 Aug; Vol. 15 (3), pp. 225-240. Date of Electronic Publication: 2017 Dec 12. - Publication Year :
- 2018
-
Abstract
- Asthma and chronic obstructive pulmonary disease (COPD) cause significant morbidity and mortality worldwide, primarily through exacerbations. Exacerbations are often treated with antibiotics but their optimal course duration is uncertain. Reducing antibiotic duration may influence antimicrobial resistance but risks treatment failure. The objective of this article is to review published literature to investigate whether shorter antibiotic therapy duration affects clinical outcomes in the treatment of asthma and COPD exacerbations. We systematically searched electronic databases (MEDLINE, EMBASE, CINAHL, World Health Organisation International Clinical Trial Registry Platform, the Cochrane library, and ISRCTN) with no language, location, or time restrictions. We retrieved observational and controlled trials comparing different durations of the same oral antibiotic therapy in the treatment of acute exacerbations of asthma or COPD in adults. We found no applicable studies for asthma exacerbations. We included 10 randomized, placebo-controlled trials for COPD patients, all from high-income countries. The commonest studied antibiotic class was fluoroquinolones. Antibiotic courses shorter than 6 days were associated with significantly fewer overall adverse events (risk ratio (RR): 0.84, 95% confidence interval (CI): 0.75-0.93, p = 0.001) when compared with those of 7 or more days. There was no statistically significant difference for clinical success or bacteriological eradication in sputum (RR: 1.00, 95% CI: 0.88-1.13 and RR: 1.06, 95% CI: 0.79-1.44, respectively). Shorter durations of antibiotics for COPD exacerbations do not seem to confer a higher risk of treatment failure but are associated with fewer adverse events. This is in keeping with previous studies in community acquired pneumonia, but studies were heterogeneous and differed from usual clinical practice. Further observational and prospective work is needed to explore the significance of antibiotic duration in the treatment of asthma and COPD exacerbations.
- Subjects :
- Anti-Bacterial Agents adverse effects
Asthma drug therapy
Disease Progression
Fluoroquinolones adverse effects
Humans
Randomized Controlled Trials as Topic
Sputum microbiology
Symptom Flare Up
Time Factors
Anti-Bacterial Agents administration & dosage
Fluoroquinolones administration & dosage
Pulmonary Disease, Chronic Obstructive drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1479-9731
- Volume :
- 15
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Chronic respiratory disease
- Publication Type :
- Academic Journal
- Accession number :
- 29232988
- Full Text :
- https://doi.org/10.1177/1479972317745734