Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis
Abstract Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common reason for the hospitalization and death of pulmonary patients. The use of antibiotics as adjuvant therapy for AECOPD, however, is still a matter of debate. Methods In this study, we searched...
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doaj-8b510613d90f431abf9298e84c3b2f322020-11-24T21:08:48ZengBMCBMC Pulmonary Medicine1471-24662017-12-0117111110.1186/s12890-017-0541-0Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysisHai-Lin Zhang0Min Tan1Ai-Min Qiu2Zhang Tao3Chang-Hui Wang4Department of Respiration, Shanghai Tenth People’s Hospital, Clinical Medical College, Nanjing Medical UniversityDepartment of Respiration, Shanghai Tenth People’s Hospital, Clinical Medical College, Nanjing Medical UniversityDepartment of Respiration, The Affiliated Yancheng Hospital, School of Medicine, Southeast UniversityDepartment of Respiration, The Affiliated Yancheng Hospital, School of Medicine, Southeast UniversityDepartment of Respiration, Shanghai Tenth People’s Hospital, Clinical Medical College, Nanjing Medical UniversityAbstract Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common reason for the hospitalization and death of pulmonary patients. The use of antibiotics as adjuvant therapy for AECOPD, however, is still a matter of debate. Methods In this study, we searched the PubMed, EmBase, and Cochrane databases for randomized controlled trials published until September 2016 that evaluated the use of antibiotics for AECOPD treatment. The major outcome variables were clinical cure rate and adverse effects. The microbiological response rate, relapse of exacerbation, and mortality were also analysed. A random-effect network was used to assess the effectiveness and tolerance of each antibiotic used for AECOPD treatment. Results In this meta-analysis, we included 19 articles that assessed 17 types of antibiotics used in 5906 AECOPD patients. The cluster ranking showed that dirithromycin had a high clinical cure rate with a low rate of adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole had high clinical cure rates with median rates of adverse effects. In terms of the microbiological response rate, only doxycycline was significantly better than placebo (odds ratio (OR), 3.84; 95% confidence interval (CI), 1.96–7.54; p < 0.001). There were no other significant results with respect to the frequency of recurrence or mortality. Conclusions Our study indicated that dirithromycin is adequate for improving the clinical cure rate of patients with AECOPD with few adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole are also recommended for disease treatment. However, caution should still be exercised when using antibiotics to treat AECOPD. Trial Registration Not applicable.http://link.springer.com/article/10.1186/s12890-017-0541-0AntibioticExacerbationChronic obstructive pulmonary diseaseMeta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hai-Lin Zhang Min Tan Ai-Min Qiu Zhang Tao Chang-Hui Wang |
spellingShingle |
Hai-Lin Zhang Min Tan Ai-Min Qiu Zhang Tao Chang-Hui Wang Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis BMC Pulmonary Medicine Antibiotic Exacerbation Chronic obstructive pulmonary disease Meta-analysis |
author_facet |
Hai-Lin Zhang Min Tan Ai-Min Qiu Zhang Tao Chang-Hui Wang |
author_sort |
Hai-Lin Zhang |
title |
Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
title_short |
Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
title_full |
Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
title_fullStr |
Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
title_full_unstemmed |
Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
title_sort |
antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis |
publisher |
BMC |
series |
BMC Pulmonary Medicine |
issn |
1471-2466 |
publishDate |
2017-12-01 |
description |
Abstract Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common reason for the hospitalization and death of pulmonary patients. The use of antibiotics as adjuvant therapy for AECOPD, however, is still a matter of debate. Methods In this study, we searched the PubMed, EmBase, and Cochrane databases for randomized controlled trials published until September 2016 that evaluated the use of antibiotics for AECOPD treatment. The major outcome variables were clinical cure rate and adverse effects. The microbiological response rate, relapse of exacerbation, and mortality were also analysed. A random-effect network was used to assess the effectiveness and tolerance of each antibiotic used for AECOPD treatment. Results In this meta-analysis, we included 19 articles that assessed 17 types of antibiotics used in 5906 AECOPD patients. The cluster ranking showed that dirithromycin had a high clinical cure rate with a low rate of adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole had high clinical cure rates with median rates of adverse effects. In terms of the microbiological response rate, only doxycycline was significantly better than placebo (odds ratio (OR), 3.84; 95% confidence interval (CI), 1.96–7.54; p < 0.001). There were no other significant results with respect to the frequency of recurrence or mortality. Conclusions Our study indicated that dirithromycin is adequate for improving the clinical cure rate of patients with AECOPD with few adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole are also recommended for disease treatment. However, caution should still be exercised when using antibiotics to treat AECOPD. Trial Registration Not applicable. |
topic |
Antibiotic Exacerbation Chronic obstructive pulmonary disease Meta-analysis |
url |
http://link.springer.com/article/10.1186/s12890-017-0541-0 |
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