Doxycycline for Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

In a small randomized trial, 30-day outcomes were no better with doxycycline than with placebo.

The role of antibiotics in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains controversial; the relevant trials were conducted before the benefits of systemic steroids were known.

In a recent industry-supported, placebo-controlled trial, researchers reexamined this issue among adults admitted for AECOPD to two medical centers in the Netherlands (223 patients; 265 exacerbations). Per inclusion criteria, none of the patients had fever (temperature =38.5°C), recent antibiotic treatment for =24 hours, or radiographic evidence of pneumonia. For each exacerbation, participants received a fixed tapering dose of intravenous and oral prednisolone as well as nebulized bronchodilator therapy. Patients were randomized by exacerbation to receive 7 days of doxycycline (128 exacerbations) or placebo (137 exacerbations). For most exacerbations (87% involving doxycycline and 80% involving placebo), participants completed the 30-day follow-up period.

The primary endpoint — clinical success (cure or improvement) at day 30 — was observed in 78 (61%) of the exacerbations randomized to doxycycline compared with 72 (53%) of those randomized to placebo (P=0.32). However, clinical success on day 10 occurred in 103 doxycycline-group exacerbations (80%) compared with 94 placebo-group ones (69%; P=0.03), and open-label antibiotics were prescribed because of lack of improvement by day 10 for 19 doxycycline-group exacerbations (15%) compared with 38 placebo-group exacerbations (28%; P=0.01). Changes in lung function and in serum C-reactive protein concentrations were similar between groups at days 10 and 30.


Citation(s):

Daniels JMA et al. Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010 Jan 15; 181:150.