Antibiotic use and outcomes in chronic obstructive pulmonary disease exacerbations

Purpose The purpose of the study was to evaluate if there is a difference in clinical worsening for patients receiving different antibiotics for COPD exacerbations.

This was a multicenter, retrospective cohort study. Inclusion criteria were: adults whose indication for antibiotics was a COPD exacerbation; who received azithromycin, doxycycline, levofloxacin, or a beta-lactam for more than 48 hours; who received no more than 48 hours of combination initial antibiotics; and who were discharged with certain bronchodilators. The primary endpoint was clinical worsening defined by antibiotic/steroid escalation/addition. Secondary endpoints included days of antibiotic therapy, length of stay and 30-day readmissions.

A total of 2,390 patients were identified for review with 114 patients included and 1,054 patients excluded. Patients were screened in reverse chronological order using quota convenience sampling. Clinical worsening occurred in 29% of azithromycin patients, 23% of doxycycline patients, 19% of levofloxacin patients, and 24% of beta-lactam patients; however, a Pearson Chi-Square test (χ2 = 0.911, p = 0.8227) showed no statistically significant association between antibiotic group and likelihood of escalation. Secondary outcomes that were statistically significant included the average cumulative inpatient and outpatient prednisone milligram equivalents with beta-lactams compared to azithromycin, which was 252 milligrams higher (p = 0.0161). Days of therapy (DOT) was statistically different for azithromycin compared to all of the other antibiotics.

This study concluded that there were no associated differences between groups for clinical worsening. This study showed a trend that narrow spectrum antibiotics, such as doxycycline and azithromycin, have similar outcomes as more broad spectrum antibiotics. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was IRB approved by WCG IRB. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Co-Author Disclaimer: The views expressed in this article are not an official position of the institution or funder. Declaration of interest statement: The authors have no relevant financial relationships or interests to disclose. Funding: There were no outside or additional funding sources for this research project. Data Availability All data produced in the present study are available upon reasonable request to the authors