Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD

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.