AMSTERDAM - Patients suffering from chronic obstructive pulmonary disease are commonly treated with antibiotics for any exacerbation of their symptoms.

However, initiating antibiotics, on top of their regular medications, only makes a small difference in the immediate short-term, a recent study suggests.

The role of antibiotics in acute exacerbations of COPD has recently become controversial and their efficacy when added to systemic corticosteroids is unknown, write Dr Johannes Daniels and his colleagues of the University of Amsterdam, The Netherlands, in the American Journal of Critical Care Medicine.

The researchers conducted a randomised, placebo-controlled study in order to determine the benefit of doxycycline in addition to corticosteroids and optimal inhalative treatment with bronchodilators on clinical outcome, microbiological outcome, lung function, and systemic inflammation in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease.

In 223 patients admitted to hospital, a total of 265 exacerbations were diagnosed, based on clinical features such as increased shortness of breath and increased sputum production. All patients were on standard treatment comprising systemic corticosteroids, bronchodilators and physiotherapy.

Within 24 hours of admission, patients were randomly assigned to an additional treatment with 200 mg of oral doxycycline for 7 days, (128 exacerbations) or placebo (137 exacerbations).

Clinical and microbiological response, time to treatment failure, lung function, symptom scores, and serum C-reactive protein were assessed.

After one month, clinical success was similar in the patients treated with the antibiotic (61%) as compared to controls (53%). Patients treated with doxycycline, however, had an advantage after 10 days: their symptoms were less pronounced and they showed higher rates of clinical cure (80 vs. 69%; p = 0,03).

Treatment with doxycycline was not associated with improvements in either lung function or C-reactive protein levels at day 10 or 30, the researchers note.

Although, after one month, antibiotic treatment did not prove superior to placebo, patients on doxycycline did experience a more rapid recovery.

“Doxycycline showed superiority in terms of clinical success and clinical cure on day 10, microbiological success, the use of open label antibiotics, and symptoms,” the authors conclude.

Reference:
Daniels JMA et al. Antibiotics in addition to systemic corticosteroids for acute exacerbations of COPD. Am J Respir Crit Care Med. 2010;181:150-157