Sg. Adams et al., Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD, CHEST, 117(5), 2000, pp. 1345-1352
Citations number
49
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background: COPD is a complex disease with exacerbations characterized by w
orsening of symptoms resulting in deteriorating lung function.
Study objective: To assess predictive factors of relapse for patients with
acute exacerbations of COPD (AECB).
Design: Retrospective cohort analysis of visits for AECB,
Setting: Veterans Affairs Medical Center.
Patients: Three hundred sixty-two visits (173 patients) with documented COP
D treated as outpatients for AECB.
Measurements: Severity of underlying COPD, severity of AECB, comorbid condi
tions, therapy, and relapse rates (return visit within 14 days with persist
ent or worsening symptoms).
Results: Each. visit was analyzed individually (referred to as a patient-vi
sit). One group received antibiotics (270 patient-visits), and the second g
roup (92 patient-visits) did not. Both groups had similar demographics and
severity of underlying COPD, The overall relapse rate was 22%. The majority
of patient-visits (95%) with severe symptoms at presentation were prescrib
ed antibiotics vs only 40% of those with mild symptoms, Twenty-nine of 92 p
atient-visits (32%) were followed by relapse in the group that was not give
n antibiotics, whereas only 50 of 270 (19%) treated with antibiotics relaps
ed (p < 0.001), Those treated with amoxicillin had an even higher relapse r
ate (20 of 37 patient-visits, or 54%) than those who did not receive antibi
otics (p = 0.006).
Conclusions: Relapse from AECB was not related to the severity of underlyin
g disease or to the severity of the acute exacerbation. Patients treated wi
th antibiotics had significantly lower relapse rates than those who did not
receive antibiotics. However, the specific choice of antibiotic is importa
nt because those treated with amoxicillin had the highest relapse rates of
all groups.