Prophylactic antibiotics for individuals with Chronic Obstructive Pulmonary Disease (COPD): a rapid review
Health Quality Ontario
Record ID 32015000489
English
Authors' recommendations:
The evidence yielded mixed results on the effectiveness and safety of the prophylactic use of the antibiotic azithromycin (AZM) for COPD patients.
From the examination of 1 systematic review of RCTs (in Rapid Review, proper):
Compared with placebo, prophylactic treatment with AZM in moderate to severe COPD patients at increased risk of future exacerbations significantly:
o increased time to first exacerbation (GRADE quality of evidence: Moderate)
o decreased the frequency of exacerbations (GRADE: Moderate)
o shortened the duration of exacerbations (GRADE: Low)
Compared with placebo, prophylactic treatment with AZM in moderate to severe COPD patients at increased risk of future exacerbations was associated with significant occurrence of adverse events, including:
o GI adverse events (GRADE: Very low)
o hearing impairment (GRADE: Moderate)
o increased likelihood of colonization with macrolide-resistant organisms (i.e., increased risk of macrolide resistance) (GRADE: Moderate)
From the examination of 2RCTs (in addendum to Rapid Review):
Based on a single RCT conducted on COPD patients who had experienced 3 or more exacerbations in the previous year, prophylactic AZM therapy compared with placebo:
o increased the time to first exacerbation
o reduced the frequency of exacerbations
o increased the likelihood of diarrhoea
o reduced the likelihood of colonization with macrolide-resistant organisms (i.e., reduced risk of macrolide resistance), for which no explanation was provided
Based on a single RCT conducted on COPD patients with chronic productive cough, no difference was found between the AZM and placebo groups in
o effect on exacerbations
o GI adverse events
The evidence showed both a general trend of beneficial effect on patients' COPD exacerbation rates and uncertainty around the risk of adverse events and antibiotic resistance associated with prophylactic AZM therapy.
Details
Project Status:
Completed
Year Published:
2015
URL for published report:
http://www.hqontario.ca/Portals/0/Documents/eds/rapid-reviews/qbp-copd-prophylactic-antibiotics-20141311-en.pdf
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Pulmonary Disease, Chronic Obstructive
Contact
Organisation Name:
Health Quality Ontario
Contact Address:
Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5
Contact Name:
EDSinfo@hqontario.ca
Contact Email:
OH-HQO_hta-reg@ontariohealth.ca
Copyright:
Health Quality Ontario
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.