Two-Day Course of Antibiotics for COPD Exacerbation?

Daniel D. Dressler, MD, MSc, MHM, FACP, reviewing Messous S et al. Ther Adv Respir Dis 2022 Jun 3

Guidelines recommend 5 to 7 days of antimicrobial therapy for patients with chronic obstructive pulmonary disease (COPD) exacerbations who exhibit all three cardinal symptoms (i.e., increased dyspnea, increased sputum volume, increased sputum purulence) or increased purulence plus one other symptom (Global Initiative for Chronic Obstructive Lung Disease guidelines). Shorter antimicrobial regimens rarely have been studied. Tunisian investigators randomized 310 adults who presented to an emergency department (ED) with acute exacerbations of COPD and at least two cardinal symptoms to receive either 2 or 7 days of levofloxacin (500 mg daily dose). Patients thought to have pneumonia were excluded. All enrolled patients received other standard therapies, including 5 days of systemic corticosteroids, and all patients received treatments in the ED for 48 hours prior to being discharged home or admitted to the hospital.

Only one quarter of patients required hospital admission (beyond the 48-hour ED stay). Patients who received 2 days or 7 days of antibiotics had similar 30-day clinical cure rates (79% and 74%; P=0.28), need for additional antibiotics, intensive care unit admissions, additional exacerbations within 1 year, 1-year mortality, and exacerbation-free intervals (medians, 121 days and 110 days).