Should COPD Patients Receive Antibiotics After an Exacerbation?

Doxycycline added to the oral corticosteroid prednisoline does not decrease frequency of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD), according to a recent study.

Although antibiotics have not been shown to reduce mortality or short-term treatment non-response in COPD outpatients experiencing acute exacerbations, little data exists on the long-term effects of antibiotics in this patient population.
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The randomized, double-blind, placebo-controlled trial assessed COPD patients recruited from outpatient clinics of 9 teaching hospitals and 3 primary care centers in the Netherlands from December 22, 2010, to August 6, 2013. In order to qualify for the trial, participants had to be at least 45 years old and have a smoking history of at least 10 pack-years, mild to severe COPD (Global Initiative of Chronic Obstructive Lung Disease [GOLD] stage 1 to 3), and at least 1 exacerbation over the previous 3 years.

A total of 305 participants were randomly assigned to receive oral doxycycline, 100 mg daily (200 mg on the first day), or placebo for 7 days. Patients in both groups also received 30 mg of oral prednisolone daily for 10 days.

The researchers identified the primary outcome as time to next exacerbation in all patients randomized to doxycycline or placebo.

After randomly assigning 152 patients to doxycycline and 153 to placebo, 85% of patients had another exacerbation (131 in the doxycycline group compared with 126 in the placebo group). The researchers determined that median time to next exacerbation was 148 days in the doxycycline group and 161 days in the placebo group.

Ultimately, the researchers found no significant differences between each group in the frequency of adverse events during the first 2 weeks after randomization or in serious adverse events during the 2 years of follow-up.

“In patients with mild-to-severe COPD receiving treatment for an exacerbation in an outpatient setting, the antibiotic doxycycline added to the oral corticosteroid prednisolone did not prolong time to next exacerbation compared with prednisolone alone,” the researchers concluded. “These findings do not support prescription of antibiotics for COPD exacerbations in an outpatient setting.”

—Christina Vogt

Reference:

van Velzen P, ter Riet G, Bresser P, et al. Doxycycline for outpatient-treated acute exacerbations of COPD: a randomised, double-blind placebo-controlled trial. Lancet Respir Med. 2017;5(6):492-499. doi:10.1016/S2213-2600(17)30165-0.