| Saint S et al, 1995, USA | 9 randomised trials (n = 1101) including npatients and outpatients with exacerbations of COPD | Meta-analysis | Mortality benefit of antibiotics v placebo, (effect size transformed into units of standard deviation) | 0.22 (95% CI 0.10 to 0.34). | English language search only |
| | | Change in peak expiratory flow rate | Small but significant improvement | Variety of antibiotics combined to produce these figures |
| | | | 10.75 l/min (95% CI, 4.96 to 16.54l/min) (6 trials 836 patiens) | |
|
British Thoracic Society 1997
| Initiated by the Standards of Care Committee of the British Society. A core group of individuals produced background papers that were collated into a single document. This was discussed over a two day period by a larger group which included respiratory physicians from both teaching and teaching and district general hospitals across the UK, geriatricians, general practitioners, nurses, and public health physicians | Systematic review and guideline | Situations in which antibiotics are proven to be of use in hospital and non-hospital settings | When two of the following three are present: | Paper search strategy may not have been systematic, search methods not fully described |
| | | Duration of treatment | (1) increased breathlessness | |
| | | Antibiotic of choice | (2) increased sputum volume | |
| | | | (3) development of purulent sputum | |
| | | | Any patient with pH<7.35 should also receive antibiotics | |
| | | | A maximum of 7 days should always be sufficient | |
| | | | Oral treatment with common antibiotics such as amoxicillin or tetracycline should be considered first choice | |
| Mcrory DC et al, 2001 | Systematic review conducted by a joint panel from the American College of Physicians (ACP)-American Society for Internal Medicine (ASIM) and the American College of Chest Physicians (ACCP) | Systematic review | Findings from 11 RCTs looking at antibiotics v placebo (They found two additional papers to the meta-analysis of Saint et al) | Three papers found a statistical benefit, 3 papers found a non-significant benefit and the remainder showed no benefit. | Study effects were not summarised by meta-analysis |
| | | Number of days of administration | Benefits were larger, the more severe the exacerbation | |
| | | | Days of administration ranged from 3 to 10 days in these studies | |
|
NICE 2003
| Full NICE guideline for the management of patients with COPD | Systematic review | Grade A recommendations | Antibiotics should be used to treat exacerbations of COPD associated with a history of purulent sputum | |
| Note: currently only in its 2nd draft. 270 received antibiotics, 92 did not. | | Grade B recommendations | Antibiotics are more likely to be helpful in patients with more severe underlying disease | |
| | | | Patients with exacerbations without purulent sputum do not need antibiotic therapy unless there is consolidation on a chest radiograph or clinical signs of pneumonia | |