Antibiotic therapy improves moderate exacerbations of mild-to-moderate COPD

September 7, 2012

Antibiotic treatment with amoxicillin/clavulanate improves moderate exacerbations in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) and significantly prolongs the time between exacerbations, according to a new study from researchers in Spain.

"The existing evidence for antibiotic therapy in non-severe exacerbations of COPD is weak," said lead author Carl Llor, MD, PhD of the University Rovira i Virgili in Tarragona, Spain. "The results of our multicenter, randomized, double-blind, placebo-controlled trial show that antibiotic treatment is more effective than placebo in these patients, with an absolute difference in cure rates of 14.2%, and that the median time to next exacerbation is prolonged with antibiotic treatment, compared with placebo, from 160 to 233 days."

The findings were published online ahead of print publication in the 's American Journal of Respiratory and .

A total of 310 patients were enrolled in the study and randomized to receive either amoxicillin/clavulanate (500/125 mg) or placebo three times daily for eight days. All participants were at least 40 years old and had a spirometrically-confirmed diagnosis of mild-to-moderate COPD. The primary endpoint was clinical cure at the end of therapy visit.

A total of 117 patients in the amoxicillin/clavulanate group (74.1%) and 91 in the placebo group (59.9%) were considered cured at follow-up. Median time to next exacerbation was significantly longer in the amoxicillin/clavulanate group. Clinical success, defined as either cure or improvement, was achieved in 90.5% of the antibiotic-treated group, compare with 80.9% of the . Capillary C-reactive protein (CRP) at a cutoff of 40 mg/l was found to be an excellent predictor of clinical outcome; patients with below 40 mg/l were significantly more likely to be cured without the .

The study had a few limitations, including a limited sample size and the lack of objective assessment of symptom resolution at follow-up, other than peak flow measurements.

"The clinical success rate we saw with amoxicillin/clavulanate treatment in our patients with mild-to-moderate COPD is higher than what has been seen in previous placebo-controlled trials which included patients with severe COPD," Dr. Llor said. "This suggests an effect of the severity of airflow obstruction on the rate of treatment success."

"We have shown that antibiotic treatment is superior to placebo in improving exacerbations in mild-to-moderate COPD," Dr. Llor concluded. "Many of these patients are treated in primary care settings, and our study supports the use of antibiotics to treat mild to moderate airway obstruction, mainly in patients with elevated CRP levels."

Explore further: Assessment of COPD exacerbation severity with the COPD Assessment Test

Related Stories

Assessment of COPD exacerbation severity with the COPD Assessment Test

January 27, 2012
Exacerbation severity in patients with chronic obstructive pulmonary disease (COPD) can be reliably assessed with the COPD Assessment Test (CAT), according to a new study from the UK.

Recommended for you

New Lyme disease tests could offer quicker, more accurate detection

December 7, 2017
New tests to detect early Lyme disease - which is increasing beyond the summer months -could replace existing tests that often do not clearly identify the infection before health problems occur.

Spinal tap needle type impacts the risk of complications

December 6, 2017
The type of needle used during a lumbar puncture makes a significant difference in the subsequent occurrence of headache, nerve irritation and hearing disturbance in patients, according to a study by Hamilton medical researchers.

Men with HPV are 20 times more likely to be reinfected after one year

December 5, 2017
A new analysis of genital human papillomavirus (HPV) in men shows that infection with one HPV type strongly increases the risk of reinfection with the same type. In fact, men who are infected with the type responsible for ...

New tuberculosis drugs possible with understanding of old antibiotic

December 5, 2017
Tuberculosis, and other life-threatening microbial diseases, could be more effectively tackled with future drugs, thanks to new research into an old antibiotic by the University of Warwick and The Francis Crick Institute.

Scientists create successful mass production system for bioengineered livers

December 5, 2017
Researchers report creating a biologically accurate mass-production platform that overcomes major barriers to bioengineering human liver tissues suitable for therapeutic transplant into people.

Trials show inactivated Zika virus vaccine is safe and immunogenic

December 5, 2017
The investigational Zika purified inactivated virus (ZPIV) vaccine was well-tolerated and induced an immune response in participants, according to initial results from three Phase 1 clinical trials. Scientists at the Walter ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

alfie_null
not rated yet Sep 08, 2012
Suggests testing with other antibiotics (hasn't this been done with azithromycin?)
Also, contrast benefit with risks (bad side effects) of long term antibiotic use?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.