Takeaway
- A meta-analysis of 68 randomized controlled trials (RCTs) finds that systemic antibiotics and corticosteroids are associated with fewer treatment failures than placebo.
- Systemic antibiotics are also associated with a greater likelihood of exacerbation resolution.
- Exacerbation severity did not affect these results.
Why this matters
- This is one of the first comparative meta-analyses of its kind.
- Findings support the use of corticosteroids or antibiotics for mild to severe exacerbations but not other medications.
Study design
- A meta-analysis of 68 RCTs (n>10,700 adults in out-patient or in-patient facilities).
- Funding: US Agency for Healthcare Research and Quality.
Key results
- Regardless of exacerbation severity, antibiotics vs placebo or management without antibiotics were associated with:
- Better exacerbation resolution after a 3-14-day trial:
- OR, 2.03 (95% CI, 1.47-2.80); and
- Less treatment failure:
- OR, 0.54 (95% CI, 0.34-0.86).
- Better exacerbation resolution after a 3-14-day trial:
- Systemic corticosteroids vs placebo in out- and in-patients for 9-56 days were associated with less treatment failure (OR, 0.01; 95% CI, 0.00-0.13), regardless of exacerbation severity.
- They were, however, linked to a greater number of total and endocrine-related adverse events.
- The evidence was insufficient for other interventions, such as aminophyllines, magnesium sulfate, anti-inflammatories, inhaled corticosteroids, and short-acting bronchodilators.
Limitations
- No head-to-head comparisons of individual medications.
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