Early Administration of Antibiotics Improves COPD-related Health Outcomes

Administering antibiotics quickly after a patient has been hospitalized for an acute exacerbation of COPD improves health outcomes, according to the results of a recent study from Baystate Medical Center, led by Michael B. Rothberg, MD, MPH.

Patients who received antibiotics within two days of their admission experienced better health outcomes, such as a lower likelihood of mechanical ventilation after the second hospital day (1.07% compared to 1.80%) and fewer readmissions (7.91% compared to 8.79%) than patients who received antibiotics three or more days after admission or not at all. Individuals who were treated with antibiotics also had a lower incidence of treatment failure (9.77% compared to 11.75%) and a decreased rate of inpatient mortality (1.04% compared to 1.59%). Although the length of hospital stay was similar in both groups, patients who were treated with antibiotics had lower costs.

Although patients given antibiotics were initially found to have higher rates of readmission for C. difficile infection, further analysis revealed that the risk of treatment failure was actually lower in antibiotic-treated patients.

"Analysis stratified by risk of treatment failure found similar magnitudes of benefit across all subgroups," the authors wrote in regard to the C. difficile findings. The study was published in JAMA.

The researchers examined a total of 84,621 patients for the study, with 79% receiving at least two consecutive days of antibiotic treatment.

In their conclusion, the researchers pointed out two particular findings—all patient groups seemed to benefit from antibiotic therapy, and harm was minimal—and stated that these findings support the idea that all patients who are hospitalized for an acute exacerbation of COPD should be treated with antibiotics. However, they do caution that there may be other factors to consider before administering antibiotics.

“Early antibiotic administration was associated with improved outcomes among patients hospitalized for acute exacerbations of COPD regardless of the risk of treatment failure,” the researchers wrote in JAMA. "This recommendation, however, is not consistent with the fact that roughly 50% of COPD patients do not have a bacterial etiology for their exacerbation. Identifying these patients remains a challenge, because sputum cultures do not distinguish between active infection and colonization. New bacterial infections may cause exacerbations and are associated with increases in inflammatory markers, … whereas colonization is not."