SynthesisRespiratory research2007
Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review.
Synthesis in Respiratory research, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 83 citations in OpenAlex.
- Antibiotics for exacerbations of chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2018Pooled it
- Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review.BMC medicine · 2008Pooled it
- Trial
- Trial
- Efficacy of amoxycillin versus amoxycillin/clavulanate in acute exacerbations of chronic pulmonary obstructive disease in primary care.International journal of chronic obstructive pulmonary disease · 2009Trial
- The use of the Prospector calculator reduces antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.Scientific reports · 2025Article
- How and when to manage respiratory infections out of hospital.European respiratory review : an official journal of the European Respiratory Society · 2022Review
- Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid-data from 43,636 outpatients.Respiratory research · 2021Article
- Prescribing Patterns for Acute Respiratory Infections in Children in Primary Health Care Centers, Makkah Al Mukarramah, Saudi Arabia.Journal of epidemiology and global health · 2018Article
- Metagenome and Metatranscriptome Profiling of Moderate and Severe COPD Sputum in Taiwanese Han Males.PloS one · 2016Article
- Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation.Annals of intensive care · 2015Article
- Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care.European journal of clinical pharmacology · 2014Article
- Necessity of amoxicillin clavulanic acid in addition to prednisolone in mild-to-moderate COPD exacerbations.BMJ open respiratory research · 2014Article
- Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study.BMC pulmonary medicine · 2013Article
- Article
- Patient-centred assessment of COPD in primary care: experience from a cross-sectional study of health-related quality of life in Europe.Primary care respiratory journal : journal of the General Practice Airways Group · 2012Article
- Factors associated with hospital admission in patients reaching the emergency department with COPD exacerbation.Multidisciplinary respiratory medicine · 2012Article
- Lung microbiology and exacerbations in COPD.International journal of chronic obstructive pulmonary disease · 2012Review
- "Ten Commandments" for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting.Frontiers in microbiology · 2011Article
- [Antibiotic prescribing in respiratory tract infections and predictive factors for their use].Atencion primaria · 2010Article
Corrections and comments
- Erratum issued
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFor decades, there is an unresolved debate about adequate prescription of antibiotics for patients suffering from exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to analyse randomised controlled trials investigating the clinical benefit of antibiotics for COPD exacerbations.
methodsWe conducted a systematic review of randomised, placebo-controlled trials assessing the effects of antibiotics on clinically relevant outcomes in patients with an exacerbation. We searched bibliographic databases, scrutinized reference lists and conference proceedings and asked the pharmaceutical industry for unpublished data. We used fixed-effects models to pool results. The primary outcome was treatment failure of COPD exacerbation treatment.
resultsWe included 13 trials (1557 patients) of moderate to good quality. For the effects of antibiotics on treatment failure there was much heterogeneity across all trials (I(2) = 75%) [corrected] Meta-regression revealed severity of exacerbation as significant explanation for this heterogeneity (p = 0.038) [corrected] Antibiotics did not reduce treatment failures in outpatients with mild to moderate exacerbations (pooled odds ratio 1.81, 95% CI 0.55-1.18, I(2) = 13%) [corrected] Inpatients with severe exacerbations had a substantial benefit on treatment failure rates (pooled odds ratio of 0.25, 95% CI 0.16-0.39, I2 = 0%; number-needed to treat of 4, 95% CI 3-5) and on mortality (pooled odds ratio of 0.20, 95% CI 0.06-0.62, I2 = 0%; number-needed to treat of 14, 95% CI 12-30).
conclusionAntibiotics effectively reduce treatment failure and mortality rates in COPD patients with severe exacerbations. For patients with mild to moderate exacerbations, antibiotics may not be generally indicated and further research is needed to guide antibiotic prescription in these patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.