BOSTON – Although a majority of chronic obstructive pulmonary disease (COPD) exacerbations are due to viral infections, treating hospitalised patients with antibiotics significantly reduces complication and mortality rates, US researchers report.

In fact, the new observational study of almost 85,000 patients admitted to hospitals for acute exacerbations of COPD only confirms current clinical guidelines for the treatment of COPD exacerbations.

In the retrospective study, the administration of antibiotics was associated with a 13% decrease in the risk of treatment failure. Treatment failure was a composite measure considering outcomes such as the need for initiation of mechanical ventilation after the second hospital day, inpatient mortality, readmission for acute exacerbations of COPD within 30 days of discharge, length of hospital stay and hospital costs.

“Respiratory infections appear to be the most frequent cause of COPD exacerbation, accounting for 50% to 80% of all exacerbations. Although as many as two-thirds of these may be viral infections, COPD treatment guidelines nevertheless recommend antibiotic treatment for patients with purulent sputum and either an increase in sputum production or an increase in dyspnoea,” write Dr Michael B. Rothberg of the Center for Quality of Care Research and his colleagues in JAMA.

Of 84,621 patients, 79% received at least 2 consecutive days of antibiotic treatment, most commonly with a quinolone (60%), a cephalosporin (37%) or a macrolide (38%). An additional 6% of patients received antibiotic therapy at some point during hospitalisation and were included with the nontreated patients.

Compared with patients not receiving antibiotics in the first 2 days, antibiotic-treated patients were less likely to be receive mechanical ventilation after the second hospital day (1.07% versus 1.80%), had lower inpatient mortality (1.04% versus 1.59%), a lower incidence of treatment failure (9.77% versus 11.75%), and lower rates of readmission for acute exacerbations of COPD (7.91% versus 8.79%).

Early antibiotic administration is associated with improved outcome, the authors conclude. The study not only validates current guidelines, but also shows that less than 80% of patients actually receive antibiotics in the first 2 days of hospitalisation, “leaving considerable room for improvement,” note the authors.

Reference:

Rothberg MB, et al. JAMA 2010; 303(20): 2035–2042.