Can antibiotics prevent acute COPD exacerbation? A systematic review and meta-analysis

OBJECTIVE:

To determine if antibiotics are efficacious in stable COPD.

METHODS:

Pubmed, embase and cochrane database of controlled trials were searched from inception to december 2012. Quality assessment was done as per cochrane collaborations tool. The extracted data were then computed using STATA software. We converted the estimates to the common metric of a relative risk, since all studies compared two groups and reported binary outcomes. RRs were pooled and we calculated average RRs across measures within each study and used the average estimate in cross-study meta-analysis.

RESULTS:

Of 3912 articles searched, 8 RCTs met the inclusion criteria. The overall estimate revealed that antibiotics (azithromycin, clarithromycin, levofloxacin) have a significant role in preventing acute exacerbation (Relative Risk = 0.702, 95% confidence interval (CI) 0.632 – 0.781, P < 0.001). The test for heterogeneity was Q= 4.143 on 7 degrees of freedom (p= 0.763).

CONCLUSION:

There is statistical evidence of the superiority of antibiotics in reducing the frequency of acute exacerbation in stable COPD warranting identification of patient groups most likely to benefit.