New Data on Prophylactic Antibiotic Therapy in COPD

Antibiotic treatment of acute bacterial exacerbations has long been a cornerstone of medical treatment. However, the role of antibiotic prophylaxis in chronic obstructive pulmonary disease (COPD) in the stable state remains controversial.

Central to COPD are chronic inflammation and bacterial colonization that lead to epithelial damage. This, in turn, can increase bacterial colonization and predispose lungs to acute bacterial infection. Theoretically, antibiotic prophylaxis could break the vicious circle between chronic bacterial colonization, inflammation and epithelial damage. However, evidence supporting this theory is scarce.

Interesting data have recently been published on MedScape on the effect of prolonged antibiotic use in moderate to severe COPD patients. One study looked at the immunomodulation effect by long-term, low-dose macrolide administration, where macrolides have previously been shown to have antibacterial and anti-inflammatory effects on chronic respiratory diseases.

After careful administration of erythromycin in moderate to severe COPD patients over a one-year period, authors of the study determined that long-term erythromycin treatment effectively reduces acute exacerbations. Therefore, macrolides have a role in COPD and may be used to augment therapy in patients with moderate to severe COPD.

Other studies focused on antibiotic treatment of acute exacerbations of chronic bronchitis (AECB) found antibiotic treatment, when added to standard medical treatment, to be protective from subsequent exacerbations and even death at two years. Further, patients who were prescribed an antibiotic for any cause but AECB had a lower risk of acute exacerbation.

Together these data suggest a possible role of antibiotic prophylaxis in COPD management, particularly in patients whose disease is moderate to severe with frequent exacerbations. They also suggest that the anti-inflammatory and/or antibacterial effect may have some beneficial effects in reducing acute exacerbations.

However, considering the huge potential population that could be involved in such prolonged treatments and the risk of adverse events, authors believe that further data are necessary before antibiotic prophylaxis can be considered in COPD as an evidence-based recommendation.

Click Here to Access “Prophylactic Antibiotic Therapy in Chronic Obstructive Pulmonary Disease: New Data” on MedScape.com (Free subscription required)