SynthesisBMC medicine2008
Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review.
Synthesis in BMC medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 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
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Antibiotics for exacerbations of chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2018Pooled it
- When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines.NPJ primary care respiratory medicine · 2015Pooled it
- Pooled it
- Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial.American journal of respiratory and critical care medicine · 2012Trial
- SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials.BMJ (Clinical research ed.) · 2025Article
- Foreign language learning can improve response inhibition in individuals with lower baseline cognition: Results from a randomized controlled superiority trial.Frontiers in aging neuroscience · 2023Article
- Effects of foreign language learning on executive functions in healthy older adults: study protocol for a randomised controlled trial.BMC geriatrics · 2021Article
- Links Between Inflammatory Bowel Disease and Chronic Obstructive Pulmonary Disease.Frontiers in immunology · 2020Review
- SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials.BMJ (Clinical research ed.) · 2013 · on this mapArticle
- Diagnostic aid to rule out pneumonia in adults with cough and feeling of fever. A validation study in the primary care setting.BMC infectious diseases · 2012Article
- Guidelines for randomized clinical trial protocol content: a systematic review.Systematic reviews · 2012Article
- Factors associated with hospital admission in patients reaching the emergency department with COPD exacerbation.Multidisciplinary respiratory medicine · 2012Article
- A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever.BMC medicine · 2011Article
- Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review.BMC medicine · 2009Review
- The problems of meta-analysis for antibiotic treatment of chronic obstructive pulmonary disease, a heterogeneous disease: a commentary on Puhan et al.BMC medicine · 2008Article
Corrections and comments
- Commented on by
Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRandomised trials comparing different drugs head-to-head are extremely valuable for clinical decision-making. However, it is scientifically and ethically sensible to demand strong evidence that a drug is effective by showing superiority over a placebo before embarking on head-to-head comparisons of potentially ineffective drugs. Our aim was to study the evolvement of evidence from placebo-controlled and head-to-head trials on the effects of antibiotics for the treatment of mild to moderate exacerbations of chronic obstructive pulmonary disease.
methodsWe conducted a historical systematic review. Through electronic databases and hand-searches, we identified placebo-controlled and head-to-head antibiotic trials for the treatment of mild to moderate chronic obstructive pulmonary disease exacerbations. We compared the numbers of patients recruited in placebo-controlled and head-to-head trials between 1957 and 2005. Using cumulative meta-analysis of placebo-controlled trials, we determined when, if ever, placebo-controlled trials had shown convincing evidence that antibiotics are effective in preventing treatment failure in patients with mild to moderate chronic obstructive pulmonary disease exacerbations.
resultsThe first head-to-head trial was published in 1963. It was followed by another 100 trials comparing different antibiotics in a total of 34,029 patients with mild to moderate chronic obstructive pulmonary disease exacerbations. Over time, the cumulative odds ratio in placebo-controlled trials remained inconclusive throughout with odds ratios ranging from 0.39 (95% confidence intervals 0.04-4.22) to the most recent estimate (1995) of 0.81 (95% confidence intervals 0.52-1.28, P = 0.37).
conclusionPlacebo-controlled trials do not support the use of antibiotics in chronic obstructive pulmonary disease patients with mild to moderate exacerbations. Conducting head-to-head trials is, therefore, scientifically and ethically questionable. This underscores the requirement to perform or study systematic reviews of placebo-controlled trials before conducting head-to-head trials.
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What OpenQuestion holds
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.