L-669. Reduced Risk of Subsequent Exacerbation and Mortality Associated with Use of Antibiotics in COPD Exacerbation
Session: Poster Session: The World of Community-Acquired Pneumonia
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Patients with an acute exacerbation of COPD are often treated with a combination of antibiotics and corticosteroids. However, in fact, only patients with severe symptoms, and/ or patients with a low baseline expiratory flow rate appear to benefit from antibiotic treatment. Most studies evaluated short-term recovery from exacerbation. Methods: We compared the long-term risk of a subsequent exacerbation of COPD after treatment with oral corticosteroids without (OS) or with antibiotics (OSA) 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. We assessed times to second and third exacerbations using Kaplan-Meier survival analysis, the risk of a subsequent exacerbation in a Cox proportional hazards analysis, and all cause mortality. Results: 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 (p < 0.01). 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 (HR 0.62; 95%CI 0.45-0.87). Conclusions: 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.
Berendina Roede, MSc1, Francois Schellevis2, Jan Prins, MD, PhD3, Patrick Bindels4, Paul Bresser4, Theo Verheij5 and  B. M. Roede, None., (1)Academic Medical Centre-University of Amsterdam, Amsterdam, Netherlands, (2)Netherlands Inst. for Health Services Res., (3)Academic Medical Center, (4)Academic Medical Centre-University of Amsterdam, (5)Julius Ctr. for Health Sci. and Primary Care, Univ. Med. Ctr., Utrecht