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Quick Use of Antibiotics Best for COPD Flare-Ups
Date:5/25/2010

Not waiting to confirm an infection improves patient outcomes, researchers say

TUESDAY, May 25 (HealthDay News) -- People hospitalized with the lung ailment chronic obstructive pulmonary disease (COPD) do better when they receive antibiotics without delay, a new study shows.

COPD patients who were given antibiotics early in their hospital stay were less likely to need mechanical ventilation and less likely to have to be readmitted to the hospital, the researchers said.

The finding could have implications for routine treatment, since "current guidelines for treating COPD exacerbations recommend antibiotics only for patients who have an increase in sputum or purulent [pus-bearing] sputum," said lead researcher Dr. Michael B. Rothberg, from Baystate Medical Center in Springfield, Mass.

"We looked to see if we could identify a group of patients who would not benefit from antibiotics, but we couldn't find one," Rothberg said.

This is not to say that all COPD patients will benefit from antibiotics, Rothberg added. "At present, we only think that about half of COPD exacerbations are caused by infection, so probably only half of patients can benefit from this therapy. The problem is that we don't know which half," he said.

The findings were published in the May 26 issue of the Journal of the American Medical Association.

COPD typically involves a combination of bronchitis and emphysema and is often tied to smoking. The disease affects some 12 million people in the United States and is the fourth leading cause of death, according to background information with the study.

According to Rothberg's group, exacerbations of COPD are responsible for more than 600,000 hospitalizations each year and result in direct costs of more than $20 billion.

For the study, Rothberg's team looked at the outcomes of almost 85,000 patients hospitalized for exacerbations of COPD in 413 U.S. hospitals from January 2006 to December 2007.

Although 79 percent of patients received antibiotics for at least two days, the timing of treatment was critical to their outcome, the researchers found.

Fewer patients whose antibiotic therapy started in the first two days after hospital admission needed to be put on a mechanical ventilator than patients whose treatment started later (1.07 percent versus 1.8 percent), the team noted.

In addition, fewer of the patients treated early on with antibiotics died (about 1 percent versus close to 1.6 percent for those treated later). Those treated early also had fewer treatment failure (about 9.8 percent versus nearly 12 percent), and a lower rate of hospital readmission for acute exacerbations of COPD (7.9 percent versus about 8.8 percent), the researchers found.

While both groups of patients stayed in the hospital for about the same length of time, the costs for those given antibiotics early was less, the researchers said.

"We need better ways of determining which patients will benefit, but for now all patients with COPD exacerbations bad enough to land them in the hospital should be treated with antibiotics," Rothberg said.

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said the results "are not surprising."

"It's rather commonplace that a patient with COPD comes in and you are looking for reasons for exacerbation," he said. "These can be inflammation, infection or some environmental problem -- most of the time, of course, you are thinking about infection as the primary reason."

Horovitz said that oftentimes, respiratory infection in COPD patients can be hard to diagnose from an X-ray. The only way to be sure the patient has pneumonia is by a lab test. But often the results are not available for a day or more.

"The way I was trained was to start antibiotics that were broad-spectrum enough that you could discontinue them should the patient not require it," he said. "These findings are consistent with the way I approach patients and it did not surprise me that those patients would fare better than patients in whom antibiotics were withheld, pending [lab] cultures."

More information

For more on COPD, visit the U.S. National Heart, Lung, and Blood Institute.



SOURCES: Michael B. Rothberg, M.D., M.P.H., Baystate Medical Center, Springfield, Mass.; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; May 26, 2010, Journal of the American Medical Association


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