Yuanyuan Wang1, Tanja R Zijp1, Muh Akbar Bahar1,2, Janwillem W H Kocks3, Bob Wilffert1,4, Eelko Hak1. 1. Department of PharmacoTherapy -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. 2. Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia. 3. Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
Background: As bacterial infections provoke exacerbations, COPD patients may benefit from prophylactic antibiotics. However, evidence regarding their overall benefit-risk profile is conflicting. Objectives: To update previous evidence and systematically evaluate the beneficial effects and side effects of prophylactic antibiotics in stable COPD patients. Methods: Several databases were searched up to 26 April 2017 for randomized controlled trials (RCTs) on prophylactic antibiotics in stable COPD patients. The primary outcomes were exacerbations and quality of life. Duration and schedule of antibiotics were considered in subgroup analyses. Results: Twelve RCTs involving 3683 patients were included. Prophylactic antibiotics significantly reduced the frequency of exacerbations [risk ratio (RR) 0.74, 95% CI 0.60-0.92] and the number of patients with one or more exacerbations (RR 0.82, 95% CI 0.74-0.90). Erythromycin and azithromycin appeared the most effective, with the number needed to treat ranging from four to seven. Quality of life was also significantly improved by prophylactic antibiotics (mean difference -1.55, 95% CI -2.59 to -0.51). Time to first exacerbation was prolonged in six studies, with one conflicting result. Neither the rate of hospitalization nor the rate of adverse events was significantly changed. Furthermore, no significant changes were observed in lung function, bacterial load and airway inflammation. However, antibiotic-resistant isolates were significantly increased (OR 4.49, 95% CI 2.48-8.12). Conclusions: Prophylactic antibiotics were effective in preventing COPD exacerbations and improving quality of life among stable patients with moderate to severe COPD. The choice of prophylactic antibiotics should be analysed and considered case by case, especially for long and continuous use.
Background: As bacterial infections provoke exacerbations, COPDpatients may benefit from prophylactic antibiotics. However, evidence regarding their overall benefit-risk profile is conflicting. Objectives: To update previous evidence and systematically evaluate the beneficial effects and side effects of prophylactic antibiotics in stable COPDpatients. Methods: Several databases were searched up to 26 April 2017 for randomized controlled trials (RCTs) on prophylactic antibiotics in stable COPDpatients. The primary outcomes were exacerbations and quality of life. Duration and schedule of antibiotics were considered in subgroup analyses. Results: Twelve RCTs involving 3683 patients were included. Prophylactic antibiotics significantly reduced the frequency of exacerbations [risk ratio (RR) 0.74, 95% CI 0.60-0.92] and the number of patients with one or more exacerbations (RR 0.82, 95% CI 0.74-0.90). Erythromycin and azithromycin appeared the most effective, with the number needed to treat ranging from four to seven. Quality of life was also significantly improved by prophylactic antibiotics (mean difference -1.55, 95% CI -2.59 to -0.51). Time to first exacerbation was prolonged in six studies, with one conflicting result. Neither the rate of hospitalization nor the rate of adverse events was significantly changed. Furthermore, no significant changes were observed in lung function, bacterial load and airway inflammation. However, antibiotic-resistant isolates were significantly increased (OR 4.49, 95% CI 2.48-8.12). Conclusions: Prophylactic antibiotics were effective in preventing COPD exacerbations and improving quality of life among stable patients with moderate to severe COPD. The choice of prophylactic antibiotics should be analysed and considered case by case, especially for long and continuous use.
Authors: Yuanyuan Wang; Victor Pera; H Marike Boezen; Jan-Willem C Alffenaar; Bob Wilffert; Rolf H H Groenwold; Eelko Hak Journal: Respiration Date: 2022-01-03 Impact factor: 3.966
Authors: Sadia Janjua; Alexander G Mathioudakis; Rebecca Fortescue; Ruth Ae Walker; Sahar Sharif; Christopher Jd Threapleton; Sofia Dias Journal: Cochrane Database Syst Rev Date: 2021-01-15
Authors: Yuanyuan Wang; Muh Akbar Bahar; Anouk M E Jansen; Janwillem W H Kocks; Jan-Willem C Alffenaar; Eelko Hak; Bob Wilffert; Sander D Borgsteede Journal: J Antimicrob Chemother Date: 2019-10-01 Impact factor: 5.790