Table 1 Characteristics of included trials
Study | Population | Interventions | Outcomes and length of follow-up |
|---|---|---|---|
Elmes 1957 [28] | 88 COPD patients (84% males, mean age 54 years). Patients were instructed to take antibiotic/placebo without a doctor visit as soon as new or aggravated respiratory symptoms were present. Severity of exacerbation: Mild to moderate | Group 1: Oxytetracycline 1 g/day per os for 5–7 days Group 2: Placebo for 5–7 days | Treatment success/failure (need for further antibiotics), time off work, number of days with symptoms Mean follow-up: 17 days |
Berry 1960 [27] | 58 COPD patients (53% males, mean age 59 years) with general practitioner visit for new or aggravated respiratory symptoms. Patients with severe exacerbations were not included because antibiotics were deemed indispensable. Severity of exacerbation: Mild to moderate | Group 1: Oxytetracycline 1 g/day per os for 5 days Group 2: Placebo for 5 days | Treatment success/failure (patient reported) Mean follow-up: 14 days |
Fear 1962 [29] | 62 COPD patients (% males and mean age not stated) with outpatient visit to Bronchitis and Asthma Clinic for new or aggravated respiratory symptoms. Severity of exacerbation: Mild to moderate | Group 1: Oxytetracycline 1 g/day per os for 7 days Group 2: Placebo for 7 days | Improvement of symptoms, days of illness Mean follow-up: 14 days |
Petersen 1967 [35] | 19 COPD patients (53 % males, mean age 62 years) with hospital admission for exacerbation. Severity of exacerbation: Severe | Group 1: Chloramphenicol 2 g/day (route of administration unclear) for 10 days Group 2: Placebo for 10 days | Mortality, patient-reported well-being Mean follow-up: 10 days |
Pines 1968 [37] | 30 COPD patients (% males not stated, mean age 68 years) with hospital admission for exacerbation. Severity of exacerbation: Severe | Groups 1: Penicillin 6 million units and streptomycin 1 g/day parenterally for 14 days Group 2: Placebo for 14 days | Treatment success/failure (physician reported), mortality Mean follow-up: 14 days |
Pines 1972 [36] | 259 COPD patients (100% males, mean age 71 years) with hospital admission for exacerbation. Patients with very severe exacerbation were not included because antibiotics were deemed indispensable. Severity of exacerbation: Severe | Groups 1 and 2: Tetracycline 2 g or chloramphenicol 2 g/day per os for 12 days Group 3: Placebo for 12 days | Treatment success/failure (physician reported), mortality, incidence of relapses Mean follow-up: 12 days |
Anthonisen 1987 [26] | 116 COPD patients (80% males, mean age 67 years). Initially, 173 patients were included for observation. Of these, 116 reported worsening of respiratory symptom and received randomly assigned antibiotics or placebo on an outpatient base. 57 patients did not experience an exacerbation. Severity of exacerbation: Mild to moderate | Group 1: Trimethoprim-sulfamethoxazol 1.9 g or amoxicillin 1 g or doxycycline 0.1–0.2 g/day per os for 10 days Group 2: Placebo for 10 days | Treatment success/failure (patient reported symptoms) Follow-up: 21 days |
Manresa 1987 [33] | 19 COPD patients (% males not stated, mean age 67) with hospital admission for exacerbation. Severity of exacerbation: Severe | Group 1: Cefaclor 1.5 g/day per os for 8 days Group 2: Placebo for 8 days | Duration of hospitalisation Mean follow-up: 13 days |
Allegra 1991 [25] | 335 COPD patients (73% males, mean age 63 years). Patients received antibiotic/placebo on an outpatient base in case of self-reported worsening of respiratory symptoms. Severity of exacerbation: Mild to moderate | Group 1: Amoxicillin-clavulanic acid 2 g/day per os for 5 days Group 2: Placebo for 5 days | Treatment success/failure (patient reported symptoms and clinical signs) Mean follow-up: 5 days |
Alonso Martinez 1992 [32] | 90 COPD patients (84% males, mean age 68 years) with hospital admission for exacerbation. Severity of exacerbation: Severe | Groups 1 and 2: : Trimethoprim-sulfamethoxazol 1.9 g or amoxicillin-clavulanic acid 1.9 g/day per os for 8 days Group 3: Placebo for 8 days | Treatment success (need for further antibiotics), duration of hospitalisation Mean follow-up: 8 days |
Jorgensen 1992 [30] | 270 COPD patients (43% males, mean age 60 years) with general practitioner visit for new or aggravated respiratory symptoms. Severity of exacerbation: Mild to moderate | Group 1: Amoxicillin 1.5 g/day per os for 7 days Group 2: Placebo for 7 days | Treatment success/failure (patient reported symptoms) Mean follow-up: 8 days |
Sachs 1995 [31] | 61 COPD patients (% males not stated, mean age not stated) with general practitioner visit for new or aggravated respiratory symptoms. Severity of exacerbation: Mild to moderate | Groups 1 and 2: Amoxicillin 1.5 g or co-trimoxazol 1.9 g/day per os for 7 days Group 3: Placebo for 7 days | Treatment success/failure (patient reported symptoms) Mean follow-up: 35 days |
Nouira 2001 [34] | 93 COPD patients (90% males, mean age 66 years) with admission to intensive care unit for exacerbation and need for mechanical ventilation. Severity of exacerbation: Severe | Group 1: Ofloxacin 0.4 g/day per os for 10 days Group 2: Placebo for 10 days | Treatment success (need for further antibiotics), mortality, duration of hospitalisation Mean follow-up: 10 days |