Department of PharmacoTherapy -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia.
J Antimicrob Chemother. 2018 Dec 1;73(12):3231-3243. doi: 10.1093/jac/dky326.
As bacterial infections provoke exacerbations, COPD patients may benefit from prophylactic antibiotics. However, evidence regarding their overall benefit-risk profile is conflicting.
To update previous evidence and systematically evaluate the beneficial effects and side effects of prophylactic antibiotics in stable COPD patients.
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.
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).
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.
由于细菌感染会引发 COPD 恶化，因此 COPD 患者可能会受益于预防性抗生素治疗。然而，关于其整体获益-风险特征的证据存在矛盾。
更新先前的证据，并系统评估稳定期 COPD 患者使用预防性抗生素的有益效果和副作用。
检索了多个数据库，截至 2017 年 4 月 26 日，以获取稳定期 COPD 患者使用预防性抗生素的随机对照试验（RCT）。主要结局为恶化和生活质量。抗生素的持续时间和方案在亚组分析中进行了考虑。
纳入了 12 项 RCT 共 3683 名患者。预防性抗生素可显著降低恶化的频率[风险比（RR）0.74，95%置信区间（CI）0.60-0.92]和发生一次或多次恶化的患者数量（RR 0.82，95%CI 0.74-0.90）。红霉素和阿奇霉素似乎最有效，治疗需数范围为 4 至 7 例。预防性抗生素还可显著改善生活质量（平均差-1.55，95%CI-2.59 至-0.51）。6 项研究报告了首次恶化的时间延长，其中 1 项结果相矛盾。住院率和不良事件发生率均无显著变化。此外，肺功能、细菌负荷和气道炎症也没有明显变化。但是，抗生素耐药分离株的数量显著增加（OR 4.49，95%CI 2.48-8.12）。
预防性抗生素可有效预防 COPD 恶化，并改善中重度 COPD 稳定期患者的生活质量。预防性抗生素的选择应进行分析并根据具体情况考虑，特别是对于长期连续使用。
