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March 22, 1995, Vol 273, No. 12 >
ARTICLE | March 22, 1995

Antibiotics in Chronic Obstructive Pulmonary Disease Exacerbations: Title and subTitle BreakA Meta-analysis FREE

Sanjay Saint, MD; Stephen Bent, MD; Eric Vittinghoff, PhD; Deborah Grady, MD, MPH
[+] Author Affiliations

Reprint requests to Veterans Affairs Medical Center (111A1), 4150 Clement St, San Francisco, CA 94105 (Dr Grady).


JAMA. 1995;273(12):957-960. doi:10.1001/jama.1995.03520360071042
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Article
References

Objective.  —A meta-analysis of randomized trials was performed to estimate the effectiveness of antibiotics in treating exacerbations of chronic obstructive pulmonary disease (COPD).

Data Sources.  —English-language studies published from 1955 through 1994 were retrieved using MEDLINE, Index Medicus, bibliographies, and consultation with experts. MEDLINE search terms included "COPD," "chronic bronchitis," and "antibiotic(s)."

Study Selection.  —Only randomized trials that enrolled patients having an exacerbation of COPD, used an antibiotic in the treatment group and placebo in the control group, and provided sufficient data to calculate an effect size were included in the meta-analysis.

Data Extraction.  —Descriptive and outcome data from each study were independently abstracted by two authors.

Data Synthesis.  —Overall summary effect size of the nine trials satisfying all inclusion criteria was 0.22 (95% confidence interval [CI], 0.10 to 0.34), indicating a small benefit in the antibiotic-treated group. Similar analysis of the six studies that provided data on peak expiratory flow rate changes revealed a summary effect size of 0.19 (95% CI, 0.03 to 0.35) and a summary change in peak expiratory flow rate of 10.75 L/min (95% CI, 4.96 to 16.54 L/min) in favor of the antibiotic-treated group. Sensitivity analyses did not significantly affect these results.

Conclusions.  —These analyses suggest a small but statistically significant improvement due to antibiotic therapy in patients with exacerbations of COPD. This antibiotic-associated improvement may be clinically significant, especially in patients with low baseline flow rates.(JAMA. 1995;273:957-960)

REFERENCES

1 +
US Bureau of the Census. Statistical Abstract of the United States: 1994 . 114th ed. Washington, DC: US Bureau of the Census; 1994;:95.
2 +
Woolcock AJ.  Epidemiology of chronic airways disease. Chest . 1989;;96( (suppl 3) ):302S-306S.
3 +
American Thoracic Society.  Chronic bronchitis, asthma, and pulmonary emphysema: a statement by the Committee on Diagnostic Standards for Non-tuberculous Respiratory Diseases. Am Rev Respir Dis . 1962;;85:762-768.
4 +
McHardy VU, Inglis JM, Calder MA, et al.  A study of infective and other factors in exacerbations of chronic bronchitis. Br J Dis Chest . 1980;; 74:228-238.
5 +
Chodosh S.  Treatment of acute exacerbations of chronic bronchitis: state of the art. Am J Med . 1992;;91( (suppl 6A) ):87S-92S.
6 +
Tager I, Speizer FE.  Role of infection in chronic bronchitis. N Engl J Med . 1975;;292:563-571.
7 +
American Thoracic Society.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis . 1987;;136:225-244.
8 +
Lode H.  Respiratory tract infections: when is antibiotic therapy indicated? Clin Ther . 1991;;13: 149-156.
9 +
Skudlarska BA, Scott GC.  The role of antibiotics in the management of acute exacerbation of chronic bronchitis: answers to some commonly asked questions. Mo Med . 1992;;89:289-293.
10 +
Tager IB, Speizer FE.  How best to use antibiotics in chronic bronchitis. Med Times . 1977;;105: 85-90.
11 +
Rodnick JE, Gude JK.  The use of antibiotics in acute bronchitis and acute exacerbations of chronic bronchitis. West J Med . 1988;;149:347-351.
12 +
Murphy TF, Sethi S.  Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis . 1992;;146:1067-1083.
13 +
Hosker H, Cooke NJ, Hawkey P.  Antibiotics in chronic obstructive pulmonary disease. BMJ . 1994;; 308:871-872.
14 +
 Antibiotics for exacerbations of chronic bronchitis? Lancet . 1987;;2:23-24. Editorial.
15 +
Antimicrobial treatment of chronic bronchitis. Lancet . 1975;;1:505-506. Editorial.
16 +
Burrows B, Nevin W.  Antibiotic management in patients with chronic bronchitis and emphysema. Ann Intern Med . 1972;;77:993-995.
17 +
Hennekens CH, Buring JE, Hebert PR.  Implications of overviews of randomized trials. Stat Med . 1987;;6:397-402.
18 +
Yusuf S.  Obtaining medically meaningful answers from an overview of randomized clinical trials. Stat Med . 1987;;6:281-294.
19 +
Light RJ, Pillemer DB. Summing Up: The Science of Reviewing Research . Cambridge, Mass: Harvard University Press; 1984;.
20 +
Sacks HS, Berrier J, Reitman J, Ancona-Berk VA, Chalmers TC.  Meta-analyses of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
21 +
Petitti DB. Meta-analysis, Decision Analysis, and Cost-effectiveness Analysis: Methods for Quantitative Synthesis in Medicine . New York, NY: Oxford University Press Inc; 1994;.
22 +
Rosenthal R, Rubin DB.  Comparing effect sizes of independent studies. Psychol Bull . 1982;;92:500-504.
23 +
Elmes PC, King TKC, Langlands JHM, et al.  Value of ampicillin in the hospital treatment of exacerbations of chronic bronchitis. BMJ . 1965;;2: 904-908.
24 +
Nicotra MB, Rivera M, Awe RJ.  Antibiotic therapy of acute exacerbations of chronic bronchitis. Ann Intern Med . 1982;;97:18-21.
25 +
Elmes PC, Fletcher CM, Dutton AAC.  Prophylactic use of oxytetracycline for exacerbations of chronic bronchitis. BMJ . 1957;;2:1272-1275.
26 +
Fear EC, Edwards G.  Antibiotic regimes in chronic bronchitis. Br J Dis Chest . 1962;;56:153-162.
27 +
Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA.  Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med . 1987;;106: 196-204.
28 +
Berry DG, Fry J, Hindley CP, et al.  Exacerbations of chronic bronchitis treatment with oxytetracycline. Lancet . 1960;;1:137-139.
29 +
Jorgensen AF, Coolidge J, Pedersen PA, et al.  Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. Scand J Prim Health Care . 1992;;10:7-11.
30 +
Petersen ES, Esmann V, Honcke P, Munkner C.  A controlled study of the effect of treatment on chronic bronchitis: an evaluation using pulmonary function tests. Acta Med Scand . 1967;;182:293-305.
31 +
Pines A, Raafat H, Greenfield JSB, Linsell WD, Solari ME.  Antibiotic regimens in moderately ill patients with purulent exacerbations of chronic bronchitis. Br J Dis Chest . 1972;;66:107-115.
32 +
Pines A, Raafat H, Plucinski K, Greenfield JSB, Solari M.  Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. BMJ . 1968;;2:735-738.
33 +
Manresa F, Blavia R, Martin R, Linares J, Rodriguez B, Verdaguer R.  Antibiotics for exacerbations of chronic bronchitis. Lancet . 1987;;2:394-395.
34 +
Higgins M.  Epidemiology of COPD: state of the art. Chest . 1984;;85( (suppl 6) ):3S-8S.
35 +
Gross NJ.  Chronic obstructive pulmonary disease: current concepts and therapeutic approaches. Chest . 1990;;97( (suppl 2) ):19S-23S.
36 +
Staley H, McDade HB, Paes D.  Is an objective assessment of antibiotic therapy in exacerbations of chronic bronchitis possible? J Antimicrob Chemother . 1993;;31:193-197.
37 +
Anderson G.  Pulmonary infection: the use of antibiotics in acute-on-chronic bronchitis. Postgrad Med J . 1983;;59( (suppl 3) ):179-180.
38 +
Kesten S, Chapman KR.  Physician perceptions and management of COPD. Chest . 1993;;104:254-258.
39 +
Littenberg B.  Aminophylline treatment in severe, acute asthma: a meta-analysis. JAMA . 1988;; 259:1678-1684.
40 +
Fantl JA, Cordozo L, McClish D, and the Hormones and Urogenital Therapy Committee.  Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis: first report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol . 1994;;83:12-18.
41 +
Light RJ.  Accumulating evidence from independent studies: what we can win and what we can lose. Stat Med . 1987;;6:221-228.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Bureau of the Census. Statistical Abstract of the United States: 1994 . 114th ed. Washington, DC: US Bureau of the Census; 1994;:95.
2 +
Woolcock AJ.  Epidemiology of chronic airways disease. Chest . 1989;;96( (suppl 3) ):302S-306S.
3 +
American Thoracic Society.  Chronic bronchitis, asthma, and pulmonary emphysema: a statement by the Committee on Diagnostic Standards for Non-tuberculous Respiratory Diseases. Am Rev Respir Dis . 1962;;85:762-768.
4 +
McHardy VU, Inglis JM, Calder MA, et al.  A study of infective and other factors in exacerbations of chronic bronchitis. Br J Dis Chest . 1980;; 74:228-238.
5 +
Chodosh S.  Treatment of acute exacerbations of chronic bronchitis: state of the art. Am J Med . 1992;;91( (suppl 6A) ):87S-92S.
6 +
Tager I, Speizer FE.  Role of infection in chronic bronchitis. N Engl J Med . 1975;;292:563-571.
7 +
American Thoracic Society.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis . 1987;;136:225-244.
8 +
Lode H.  Respiratory tract infections: when is antibiotic therapy indicated? Clin Ther . 1991;;13: 149-156.
9 +
Skudlarska BA, Scott GC.  The role of antibiotics in the management of acute exacerbation of chronic bronchitis: answers to some commonly asked questions. Mo Med . 1992;;89:289-293.
10 +
Tager IB, Speizer FE.  How best to use antibiotics in chronic bronchitis. Med Times . 1977;;105: 85-90.
11 +
Rodnick JE, Gude JK.  The use of antibiotics in acute bronchitis and acute exacerbations of chronic bronchitis. West J Med . 1988;;149:347-351.
12 +
Murphy TF, Sethi S.  Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis . 1992;;146:1067-1083.
13 +
Hosker H, Cooke NJ, Hawkey P.  Antibiotics in chronic obstructive pulmonary disease. BMJ . 1994;; 308:871-872.
14 +
 Antibiotics for exacerbations of chronic bronchitis? Lancet . 1987;;2:23-24. Editorial.
15 +
Antimicrobial treatment of chronic bronchitis. Lancet . 1975;;1:505-506. Editorial.
16 +
Burrows B, Nevin W.  Antibiotic management in patients with chronic bronchitis and emphysema. Ann Intern Med . 1972;;77:993-995.
17 +
Hennekens CH, Buring JE, Hebert PR.  Implications of overviews of randomized trials. Stat Med . 1987;;6:397-402.
18 +
Yusuf S.  Obtaining medically meaningful answers from an overview of randomized clinical trials. Stat Med . 1987;;6:281-294.
19 +
Light RJ, Pillemer DB. Summing Up: The Science of Reviewing Research . Cambridge, Mass: Harvard University Press; 1984;.
20 +
Sacks HS, Berrier J, Reitman J, Ancona-Berk VA, Chalmers TC.  Meta-analyses of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
21 +
Petitti DB. Meta-analysis, Decision Analysis, and Cost-effectiveness Analysis: Methods for Quantitative Synthesis in Medicine . New York, NY: Oxford University Press Inc; 1994;.
22 +
Rosenthal R, Rubin DB.  Comparing effect sizes of independent studies. Psychol Bull . 1982;;92:500-504.
23 +
Elmes PC, King TKC, Langlands JHM, et al.  Value of ampicillin in the hospital treatment of exacerbations of chronic bronchitis. BMJ . 1965;;2: 904-908.
24 +
Nicotra MB, Rivera M, Awe RJ.  Antibiotic therapy of acute exacerbations of chronic bronchitis. Ann Intern Med . 1982;;97:18-21.
25 +
Elmes PC, Fletcher CM, Dutton AAC.  Prophylactic use of oxytetracycline for exacerbations of chronic bronchitis. BMJ . 1957;;2:1272-1275.
26 +
Fear EC, Edwards G.  Antibiotic regimes in chronic bronchitis. Br J Dis Chest . 1962;;56:153-162.
27 +
Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA.  Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med . 1987;;106: 196-204.
28 +
Berry DG, Fry J, Hindley CP, et al.  Exacerbations of chronic bronchitis treatment with oxytetracycline. Lancet . 1960;;1:137-139.
29 +
Jorgensen AF, Coolidge J, Pedersen PA, et al.  Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. Scand J Prim Health Care . 1992;;10:7-11.
30 +
Petersen ES, Esmann V, Honcke P, Munkner C.  A controlled study of the effect of treatment on chronic bronchitis: an evaluation using pulmonary function tests. Acta Med Scand . 1967;;182:293-305.
31 +
Pines A, Raafat H, Greenfield JSB, Linsell WD, Solari ME.  Antibiotic regimens in moderately ill patients with purulent exacerbations of chronic bronchitis. Br J Dis Chest . 1972;;66:107-115.
32 +
Pines A, Raafat H, Plucinski K, Greenfield JSB, Solari M.  Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. BMJ . 1968;;2:735-738.
33 +
Manresa F, Blavia R, Martin R, Linares J, Rodriguez B, Verdaguer R.  Antibiotics for exacerbations of chronic bronchitis. Lancet . 1987;;2:394-395.
34 +
Higgins M.  Epidemiology of COPD: state of the art. Chest . 1984;;85( (suppl 6) ):3S-8S.
35 +
Gross NJ.  Chronic obstructive pulmonary disease: current concepts and therapeutic approaches. Chest . 1990;;97( (suppl 2) ):19S-23S.
36 +
Staley H, McDade HB, Paes D.  Is an objective assessment of antibiotic therapy in exacerbations of chronic bronchitis possible? J Antimicrob Chemother . 1993;;31:193-197.
37 +
Anderson G.  Pulmonary infection: the use of antibiotics in acute-on-chronic bronchitis. Postgrad Med J . 1983;;59( (suppl 3) ):179-180.
38 +
Kesten S, Chapman KR.  Physician perceptions and management of COPD. Chest . 1993;;104:254-258.
39 +
Littenberg B.  Aminophylline treatment in severe, acute asthma: a meta-analysis. JAMA . 1988;; 259:1678-1684.
40 +
Fantl JA, Cordozo L, McClish D, and the Hormones and Urogenital Therapy Committee.  Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis: first report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol . 1994;;83:12-18.
41 +
Light RJ.  Accumulating evidence from independent studies: what we can win and what we can lose. Stat Med . 1987;;6:221-228.

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