Prophylactic antibiotics effective for chronic obstructive pulmonary disease

Clinical question: 
How effective are prophylactic antibiotics for patients with chronic obstructive pulmonary disease (COPD)?
Bottom line: 
Use of continuous prophylactic macrolide antibiotics for a period of up to 12 months reduced the number of patients with exacerbations (NNT = 8),* exacerbation frequency and the median time to first exacerbation. There was also a significant improvement seen in health-related quality of life, though the improvement may be too small to be clinically significant. The impact of pulsed antibiotics was uncertain. Neither pulsed nor continuous antibiotics showed a significant effect on the secondary outcomes of frequency of hospital admissions, change in lung function, serious adverse events or all-cause mortality. The trials lasted from 3 months to 3 years. *NNT= number needed to treat to benefit 1 individual.
Caveat: 
All trials of continuous antibiotics used macrolides. The trials included patients who had frequent exacerbations and needed treatment with antibiotics or systemic steroids, or who were on supplemental oxygen. It is not clear from the studies the extent to which participants had other treatments for their COPD optimised (eg, smoking cessation programmes, pulmonary rehabilitation, vaccination).
Context: 
People with COPD may have exacerbations that usually occur after respiratory infections. These may lead to further irreversible loss of lung function with days off work, hospital admission, reduction in quality of life and even death.
Review CD#: 
CD009764
PEARLS No: 
426
Date: 
March, 2014
Authored by: 
Brian R McAvoy