Antibiotic treatment in exacerbations of chronic obstructive pulmonary disease

Most patients with chronic obstructive pulmonary disease (COPD) experience exacerbations. Exacerbations have major consequences, for the individual patient as well as for society. Therefore, reducing the number of exacerbations is a key outcome in clinical trials. In contrast with oral corticosteroids, the role of antibiotics is still controversial.
This thesis focused on the long- and short-term effects of antibiotic treatment in exacerbations of COPD. We performed a randomized, placebo-controlled trial that examined the long-term effects of a course of doxycycline added to oral corticosteroids in exacerbations of COPD. Treatment failure rates after two years of follow up (long-term) and treatment failure rates at day 21 (short-term) were not different between patients treated with antibiotics and patients treated with placebo. Our data show that antibiotics can be withheld in outpatients without fever that are treated with oral corticosteroids for an exacerbation of COPD. We performed subgroup analyses based on clinical variables, but could not identify those patients who benefit from antibiotic treatment. We also demonstrated that in patients with mild to severe COPD treated in an outpatient setting, doxycycline added to prednisolone is not cost-effective compared to prednisolone plus placebo. A systematic review and meta-analysis concluded that antibiotics statistically significantly reduce short-term treatment failure. This was less certain for patients that were concurrently treated with OCS and for patients without sputum purulence. Finally, we showed that breath samples analysed by gas chromatography-mass spectrometry and electronic nose have the potential to serve as a non-invasive biomarker for the diagnosis of COPD exacerbations.