research clipboardResearch results support the hypothesis of performing a randomized trial using a sputum purulence-guided antibiotic treatment strategy in patients with acute exacerbations of COPD, according to Spanish scientists.

“Excessive use of antibiotics contributes significantly to increasing bacterial resistance and increased medical costs and the risk of drug-related adverse events,” said Antoni Torres (Hospital Clinic of Barcelona, Spain) and colleagues. “Discriminate use of antibiotics in exacerbations is necessary to improve outcomes in patients with COPD.”

Researchers recruited 73 COPD patients admitted to hospital for an exacerbation, and gave them all intravenous prednisolone followed by oral prednisone treatment, as well as nebulized bronchodilators four times daily, oxygen therapy, and respiratory physiotherapy.

Those patients with purulent sputum, defined as a change in color from uncolored to yellow-green in the previous 72 hours, also received antibiotics for 7 days according to their culture and susceptibility results.

After 3 days, treatment success was comparable between the two groups, occurring in 90% of patients in the purulent group and 91% in the nonpurulent group. However, after an additional 30 days, more patients in the nonpurulent group had achieved a complete resolution of exacerbation symptoms, at 74% compared with 46% in the purulent group.

While no significant differences were noted between the groups in other measures such as length of stay, exacerbation rate, or readmissions, patients in the purulent group were more likely to have another exacerbation within 180 days than those in the nonpurulent group.

The authors also found that C-reactive protein (CRP) levels on admission were significantly associated with purulence, with a median value of 11.6 mg/dL in the purulent group compared with 5.3 mg/dL in the nonpurulent group.

The researchers have begun a randomized, double-blind trial to confirm their findings.