Early Antibiotics in COPD Hospitalizations Beneficial

Treatment in first two days linked to decreased ventilator use, mortality
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, May 25 (HealthDay News) -- Chronic obstructive pulmonary disease (COPD) patients hospitalized for exacerbations of their illness who receive antibiotic treatment within the first two days of their hospitalization fare better than those who do not, according to research published in the May 26 issue of the Journal of the American Medical Association.

Michael B. Rothberg, M.D., of Baystate Medical Center in Springfield, Mass., and colleagues conducted a retrospective cohort study of 84,621 patients age 40 and older admitted to a hospital for an acute exacerbation of COPD. Patients treated with antibiotics in the first two hospital days were compared to those not treated with antibiotics during that time frame. The main outcome measure was a composite measure of treatment failure, including in-hospital mortality, initiation of mechanical ventilation after the second hospital day or readmission within 30 days of discharge; length of hospital stay; and hospital costs.

The researchers found that those patients treated with antibiotics during the first two days (79 percent of the cohort) had lower inpatient mortality (1.04 versus 1.59 percent), lower rates of mechanical ventilation after the second day in the hospital (1.07 versus 1.80 percent), and lower rates of readmission for COPD exacerbation (7.91 versus 8.79 percent). The overall risk of treatment failure was lower in antibiotic-treated patients (odds ratio, 0.87). Antibiotic-treated patients were found to have a higher incidence of readmissions for Clostridium difficile (0.19 versus 0.09 percent).

"These two findings, that all patient groups seemed to benefit from therapy and that harms were minimal, support the notion that all patients hospitalized with acute exacerbations of COPD should be prescribed antibiotics. This recommendation, however, is not consistent with the fact that roughly 50 percent of COPD patients do not have a bacterial etiology for their exacerbation. Identifying these patients remains a challenge, because sputum cultures do not distinguish between active infection and colonization," the authors write.

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