TY  - JOUR
T1  - ANtibiotic therapy in patients hospitalized with acute chronic obstructive pulmonary disease—reply
AU  - Rothberg MB, Pekow PS, Lindenauer PK
Y1  - 2010/09/22
N1  - 10.1001/jama.2010.1340
JO  - JAMA
SP  - 1325
EP  - 1327
VL  - 304
IS  - 12
N2  - 
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.

SN  - 0098-7484
M3  - doi: 10.1001/jama.2010.1340
UR  - http://dx.doi.org/10.1001/jama.2010.1340
ER  -