Early use of antibiotics after COPD exacerbation improves patient outcomes

In late May, a group of Massachusetts based researchers published the results of a study examining the effectiveness of early antibiotic therapy for COPD patients hospitalized with an acute exacerbation. The researchers concluded that those patients who began receiving antibiotics within 2 days of admission to the hospital experienced significantly fewer inpatient complications and subsequent hospital readmission. (Rothberg M, et al. Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. JAMA. 2010; 303(20): 2035-2042)

An acute exacerbation is generally defined as a significant shortness of breath attack, often brought on by a respiratory infection and/or excess production of sputum. While it might seem commonsense to treat all COPD patients who are hospitalized due to an acute exacerbation with antibiotics, they are not consistently prescribed. According to the research team, current treatment guidelines only call for prescribing antibiotics when COPD patients are producing an increased amount of sputum. This study’s results challenge this guideline. In fact, the research team recommends providing early antibiotics to all COPD patients who are admitted to hospitals with an acute exacerbation.

In the study, the research team reviewed hospital admission records of over 80,000 COPD patients admitted over 400 U.S. hospitals between 2006 and 2007 and looked for differences in patient outcomes between those who received early antibiotics and those who did not.

While a large majority (79%) of the patients received at least 2 days of antibiotics during their hospital stay, there were notable differences in the outcomes of patients who began receiving antibiotics within the first 2 days of their stay versus those who began antibiotics later in their hospital stay. Those who received the antibiotics early in their hospital stay were less likely to be placed on mechanical ventilation, had lower inpatient mortality, and had fewer readmissions for subsequent exacerbations within the first 30 days after discharge.

The results, published in the Journal of the American Medical Association, were widely reported in media outlets around the globe. For a good synopsis of the study’s findings and some pull quotes from the research team leader, Dr. Michael Rothberg, click here.