Prophylactic antibiotics for adults with chronic obstructive pulmonary disease: a network meta-analysis

Which preventative antibiotic is effective and safe for reducing exacerbations, improving quality of life, and reducing serious side effects in people with COPD?

Bottom line

Although these NMAs show some benefit of using macrolides, they are based on a limited number of studies, and concerns remain about antibiotic resistance with long‐term use of antibiotics.

What is COPD?

COPD is a lung condition that can cause long‐term breathing problems. Symptoms include shortness of breath, cough, and sputum production. Flare‐ups (so‐called exacerbations) can be triggered by infection or inflammation, causing worsening symptoms and lung damage. Frequent exacerbations can lead to reduced quality of life and can increase the risk of death.

Why did we do this review?

We wanted to find out if one type of preventative antibiotic was better than another in reducing exacerbations, improving quality of life, and reducing side effects. We did this by using information from two previous reviews and comparing different antibiotics with each other, and with a control treatment (called placebo), by creating networks. As information was limited, the networks allowed us to combine information and determine the best preventative antibiotics by ranking them in order of ability to reduce exacerbations, improve quality of life, and reduce serious side effects.

What evidence did we find?

We tested three types of antibiotics: macrolides, quinolones, and tetracyclines.

  • Macrolides were better in reducing exacerbations compared to control treatment
  • There was no clear difference in exacerbations when quinolone or tetracycline was compared with a control treatment
  • Tetracyclines were ranked lower than placebo in reducing exacerbations
  • We used the data for each antibiotic group to rank antibiotic groups in order of their ability to reduce exacerbations. We found that macrolides ranked first, followed by quinolones (second). Tetracyclines were ranked fourth and were not better than control treatment (ranked third)
  • Macrolides improved quality of life compared with control treatment
  • Quinolones did not appear to impact quality of life
  • Tetracyclines may have been associated with worsening quality of life compared to control treatment
  • Macrolides were more effective in reducing serious unwanted events.
  • There was no clear benefit for serious unwanted events with quinolone, tetracycline, or combined macrolide plus tetracycline compared with control treatment
  • We could not clearly show benefit or harm of preventative antibiotic use for microbial resistance

Quality of the evidence

We did not find any concerns about the ways in which studies were carried out, except that for some studies, people collecting the information knew (1) which patient was included in which treatment group, and (2) patient results when treatments were completed. Overall, the numerical information was robust and was unlikely to be influenced by differences noted between individual studies.

The review is current to 22 January 2020.
This is based on the plain language summary of the review.
Read the full review here