Reduced Risk of Next Exacerbation and Mortality Associated with Use of Antibiotics in COPD

¹ Dept of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Center for Infection and Immunity Amsterdam (CINIMA); and Dept of General Practice
² Dept of Pulmonology; Academic Medical Centre-University of Amsterdam, Amsterdam, The Netherlands
³ Dept of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Center for Infection and Immunity Amsterdam (CINIMA)
⁴ Netherlands Institute for Health Services Research (NIVEL), Utrecht, and Dept of General Practice/ EMGO Institute VU University Medical Centre, Amsterdam, The Netherlands
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
⁶ Dept of General Practice

^* To whom correspondence should be addressed. E-mail: i.roede{at}amc.uva.nl.

	Abstract

The long-term risk of a subsequent exacerbation of COPD after treatment with oral corticosteroids without (OS) or with antibiotics (OSA) was compared in a historical general practice-based cohort.

Eligible were patients 50 years with a registered diagnosis of COPD on maintenance respiratory drugs, who experienced at least one exacerbation defined as a prescription OS or OSA. Times to second and third exacerbations were assessed using Kaplan-Meier survival analysis, the risk of a subsequent exacerbation in a Cox proportional hazards analysis, and all cause mortality.

842 patients had one or more exacerbations. The median time from first to second exacerbation was comparable for the OS group and the OSA group, but the time from second to third exacerbation differed: 189 versus 258 days. The protective effect of OSA was most pronounced during the first three months following treatment (HR 0.72; 95%CI 0.62–0.83). Exposure to antibiotics unrelated to a course of oral corticosteroids almost halved the risk of a new exacerbation. Mortality during follow-up was considerably lower in the OSA group.

Adding antibiotics to oral corticosteroids was associated with a reduced risk of a subsequent exacerbation, especially in patients with recurrent exacerbations, and a reduced risk of all cause mortality.