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Clinical Bottom Line(s): As soon as CAL patients develop exacerbations (2 or more of increasing dyspnoea, increased sputum, or purulent sputum), have them start ten days of: a. trimethoprim (160mg)/sulfamethoxazole (800 mg) twice daily OR b. amoxycillin (250 mg qid) OR c. doxycycline (200 mg stat and the 100 mg per day) and they will be less likely to require hospitalisation or other antibiotics. |
Appraised by: Sackett, 10 April 1995
The Evidence: [1] A 3.5 year RCT of any of three antibiotics (doc’s choice) vs identical placebos in 173 patients with CAL (mean FEV1 = 34% of expected; peak flow 228 L/min), living in and around Winnepeg Canada, who averaged about 0.6 exacerbations per year.
|
endpoints |
Control
|
Treated |
RRR |
ARR |
NNT (exacer- bations) |
|
Deteriorated to the point where they needed hospitalisation or additional antibiotic |
0.189 (34/180) |
0.099 (18/182) |
48% |
0.09 |
11 (6-59 ) Number of exacerbations you Need to Treat to prevent one deterioration |
Comments:
1. Lost a lot of patients along the way (18 died, 15 wouldn’t cooperate, and their docs withdrew an additional 17) ‘tho they didn’t differ from remainder in symptoms or lung function.
Date of expiry: 1 April 1997
REFERENCES:
[1] Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA: Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196-204.
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