Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Health Quality Ontario. Prophylactic antibiotics for individuals with Chronic Obstructive Pulmonary Disease (COPD): a rapid review. Toronto: Health Quality Ontario (HQO). Rapid Review. 2015 Authors' conclusions The evidence yielded mixed results on the effectiveness and safety of the prophylactic use of the antibiotic azithromycin (AZM) for COPD patients.
From the examination of 1 systematic review of RCTs (in Rapid Review, proper):
Compared with placebo, prophylactic treatment with AZM in moderate to severe COPD patients at increased risk of future exacerbations significantly:
o increased time to first exacerbation (GRADE quality of evidence: Moderate)
o decreased the frequency of exacerbations (GRADE: Moderate)
o shortened the duration of exacerbations (GRADE: Low)
Compared with placebo, prophylactic treatment with AZM in moderate to severe COPD patients at increased risk of future exacerbations was associated with significant occurrence of adverse events, including:
o GI adverse events (GRADE: Very low)
o hearing impairment (GRADE: Moderate)
o increased likelihood of colonization with macrolide-resistant organisms (i.e., increased risk of macrolide resistance) (GRADE: Moderate)
From the examination of 2RCTs (in addendum to Rapid Review):
Based on a single RCT conducted on COPD patients who had experienced 3 or more exacerbations in the previous year, prophylactic AZM therapy compared with placebo:
o increased the time to first exacerbation
o reduced the frequency of exacerbations
o increased the likelihood of diarrhoea
o reduced the likelihood of colonization with macrolide-resistant organisms (i.e., reduced risk of macrolide resistance), for which no explanation was provided
Based on a single RCT conducted on COPD patients with chronic productive cough, no difference was found between the AZM and placebo groups in
o effect on exacerbations
o GI adverse events
The evidence showed both a general trend of beneficial effect on patients' COPD exacerbation rates and uncertainty around the risk of adverse events and antibiotic resistance associated with prophylactic AZM therapy. Indexing Status Subject indexing assigned by CRD MeSH Antibiotic Prophylaxiss; Pulmonary Disease, Chronic Obstructive Language Published English Country of organisation Canada English summary An English language summary is available. Address for correspondence Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5 Email: EDSinfo@hqontario.ca AccessionNumber 32015000489 Date abstract record published 15/04/2015 |