Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 12;17(1):196.
doi: 10.1186/s12890-017-0541-0.

Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis

Hai-Lin Zhang  1   2 , Min Tan  1 , Ai-Min Qiu  2 , Zhang Tao  2 , Chang-Hui Wang  3
Affiliations

Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis

Hai-Lin Zhang et al. BMC Pulm Med. .

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common reason for the hospitalization and death of pulmonary patients. The use of antibiotics as adjuvant therapy for AECOPD, however, is still a matter of debate.

Methods: In this study, we searched the PubMed, EmBase, and Cochrane databases for randomized controlled trials published until September 2016 that evaluated the use of antibiotics for AECOPD treatment. The major outcome variables were clinical cure rate and adverse effects. The microbiological response rate, relapse of exacerbation, and mortality were also analysed. A random-effect network was used to assess the effectiveness and tolerance of each antibiotic used for AECOPD treatment.

Results: In this meta-analysis, we included 19 articles that assessed 17 types of antibiotics used in 5906 AECOPD patients. The cluster ranking showed that dirithromycin had a high clinical cure rate with a low rate of adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole had high clinical cure rates with median rates of adverse effects. In terms of the microbiological response rate, only doxycycline was significantly better than placebo (odds ratio (OR), 3.84; 95% confidence interval (CI), 1.96-7.54; p < 0.001). There were no other significant results with respect to the frequency of recurrence or mortality.

Conclusions: Our study indicated that dirithromycin is adequate for improving the clinical cure rate of patients with AECOPD with few adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole are also recommended for disease treatment. However, caution should still be exercised when using antibiotics to treat AECOPD. Trial Registration Not applicable.

Keywords: Antibiotic; Chronic obstructive pulmonary disease; Exacerbation; Meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

No ethical approval was required.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart illustrates the selection of studies included in our analysis
Fig. 2
Fig. 2
Graph of the bias risk of each study included
Fig. 3
Fig. 3
Network of comparisons for the clinical cure rate included in the analysis
Fig. 4
Fig. 4
Network of comparisons for the adverse effects included in the analysis
Fig. 5
Fig. 5
The cumulative ranking plots based on the estimation from SUCRA probabilities of the clinical cure rate
Fig. 6
Fig. 6
The cumulative ranking plots based on the estimation from SUCRA probabilities of adverse effects
Fig. 7
Fig. 7
The clustered ranking plot for clinical cure rates and adverse effects
See this image and copyright information in PMC

References

    1. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370(9589):765–773. doi: 10.1016/S0140-6736(07)61380-4. - DOI - PubMed
    1. Steiropoulos P, Tzouvelekis A, Bouros D. Formoterol in the management of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2008;3(2):205–215. - PMC - PubMed
    1. Spagnolo P, Fabbri LM, Bush A. Long-term macrolide treatment for chronic respiratory disease. Eur Respir J. 2013;42(1):239–251. doi: 10.1183/09031936.00136712. - DOI - PubMed
    1. Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67(11):957–963. doi: 10.1136/thoraxjnl-2011-201518. - DOI - PMC - PubMed
    1. Hurst JR. Exacerbation phenotyping in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011;184(6):625–626. doi: 10.1164/rccm.201106-1136ED. - DOI - PubMed

Publication types

MeSH terms

Substances