RT Journal
A1 Rothberg MB, Pekow PS, Lindenauer PK
T1 ANtibiotic therapy in patients hospitalized with acute chronic obstructive pulmonary disease—reply
JF JAMA
JO JAMA
YR 2010
FD September 22
VO 304
IS 12
SP 1325
OP 1327
DO 10.1001/jama.2010.1340
UL http://dx.doi.org/10.1001/jama.2010.1340
AB 
In Reply: We agree with Dr Hurley that unrecognized pneumonia might explain the observed difference in mortality between patients who did and did not receive early antibiotics. In clinical practice this would make little difference. Pneumonia can be difficult to diagnose in COPD, and the physicians in our study did not make the diagnosis, so this distinction cannot be used to guide therapy. Although we have no information about do-not-resuscitate orders, in our experience antibiotics are considered a noninvasive intervention and are usually continued even for hospice patients. The finding that patients not given antibiotics were more likely to be intubated also argues against withholding of antibiotics out of preference. We lacked reliable information about smoking status, but it is not clear why smokers would be less likely than nonsmokers to receive antibiotics. Moreover, although readmissions constituted the majority of outcomes, mortality and late ventilation were also significantly lower in the treatment group.