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Does antibiotic treatment duration affect the outcomes of exacerbations of asthma and COPD? A systematic review

Marie Stolbrink, Jack Amiry & John D Blakey
Chronic Respir Dis 2017; Published online 12 December 2017


Most asthma and chronic obstructive pulmonary disease (COPD) exacerbations are considered to be non-bacteriological, yet antibiotic prescription for exacerbations is a common clinical practice. However, few studies have investigated the optimal duration of antibiotic treatment. Marie Stolbrink and colleagues from Liverpool conducted a systematic review, following best-practice guidance from the Cochrane Collaboration, to gather evidence for antibiotic prescriptions of various lengths. No relevant studies were found in patients with asthma, but 10 studies in COPD patients were included in the review.

They found no significant association between prescription length and clinical response, bacteriological eradication in sputum, spirometric change, inflammatory markers or time to new exacerbations – but prescriptions shorter than six days were associated with a lower rate of adverse events. Many of the existing studies were undertaken more than 10 years ago, when standards for stratifying COPD severity were not widely adopted. The authors therefore believe current evidence supports the use of shorter antibiotic courses for COPD exacerbations, but call for further research to determine whether this is true in the context of present-day COPD care and antibiotic resistance.

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