COPD · Antibiotics for exacerbations
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease
| Design | Randomised, double-blind, crossover trial |
|---|---|
| Treatment | Broad-spectrum antibiotic for an exacerbation |
| Control | Placebo |
| Population | 173 patients contributing 362 exacerbations over 3.5 years |
| Inclusion criteria | Exacerbations defined by increased dyspnoea, sputum volume and sputum purulence, followed by home visit every three days. |
| Follow-up | 21 days per exacerbation |
| Primary endpoint | Resolution of the exacerbation within 21 days (treatment success) |
| Result | Success in 68% of antibiotic-treated exacerbations versus 55% with placebo. Failure with deterioration requiring intervention in 10% versus 19%. Peak flow recovered faster with antibiotic. Side effects were uncommon and did not differ between groups. |
There was a significant benefit associated with antibiotic.
The trial authors, in the published abstract
The origin of the three Anthonisen criteria, which are still how most guidelines decide who gets an antibiotic for an exacerbation. Nearly forty years on, the definition has outlived the antibiotics it was tested with.
Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987 Feb;106(2):196-204.