Which antibiotics are effective in the treatment of chronic obstructive pulmonary disease (COPD)?

Updated: Nov 13, 2020
  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Daniels et al conducted a randomized, placebo-controlled trial that compared the addition of doxycycline to corticosteroids on clinical outcome in patients hospitalized with acute exacerbation of COPD (n=223). [16] In addition to clinical outcome, other parameters were measured, including microbiological outcome, lung function, and systemic inflammation. The 223 patients enrolled in the study represented 265 COPD exacerbations. In addition to systemic corticosteroids, patients received either doxycycline 200 mg or placebo for 7 days. Results at 30 days were similar between the 2 groups. At 10 days, the doxycycline group showed superiority for clinical success compared with placebo in the intention-to-treat arm but not in the per-protocol arm. Also at day 10, doxycycline was superior for clinical cure, microbiological outcome, use of open label antibiotics, and symptoms.

In cases of severe acute exacerbations of chronic bronchitis (AECB), guidelines suggest using fluoroquinolone antibiotics as first-line therapy. [17, 18] This suggestion is based on level I evidence from several trials that show clinical and microbial superiority of these agents.

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