The study also looked at the relationship of CRP and exacerbations in the placebo group. Higher spontaneous clinical cure rates were noted when the CRP was <40 mg/L.
CAVEATS: Effects of concomitant medications are unclear
In both the placebo and antibiotic groups, patients were taking other medications (including short-and long-acting beta-agonists, anticholinergics, theophyllines, and oral or inhaled corticosteroids). Roughly the same number of patients in each group took additional medications, but researchers did not conduct a subgroup analysis to see if patients treated with these medications responded differently than those who received antibiotics alone.
GOLD guidelines already suggest antibiotics for exacerbations in patients with moderate COPD.2 In this study, 89% of patients met criteria for moderate COPD and 11% for mild COPD. Though the percentage of patients who had mild COPD was small, we believe the results of this study warrant consideration of antibiotic use in patients with mild disease. Local antibiograms may show increased resistance to amoxicillin/clavulanate; this study did not address the use of other antibiotics.
CHALLENGES TO IMPLEMENTATION: Antibiotic overuse may be a concern
With increased awareness of inappropriate antibiotic use, physicians might have concerns about antibiotic resistance developing as a result of using antibiotics for exacerbations of mild to moderate COPD.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
