Sputum color guides antibiotic treatment in COPD

Withholding antibiotic treatment from hospitalized chronic obstructive lung disease (COPD) patients with nonpurulent sputum does not negatively affect outcomes, a pilot study shows.

The authors say the findings could help refine treatment of COPD and reduce antibiotic use.

"Excessive use of antibiotics contributes significantly to increasing bacterial resistance and increased medical costs and the risk of drug-related adverse events," say Antoni Torres (Hospital Clinic of Barcelona, Spain) and colleagues.

"Discriminate use of antibiotics in exacerbations is necessary to improve outcomes in patients with COPD."

The study included 73 COPD patients admitted to hospital for an exacerbation. Of these, 39 patients had purulent sputum, defined as a change in color from uncolored to yellow-green in the previous 72 hours.

All patients received intravenous predisolone followed by oral prednisone treatment, as well as nebulized bronchodilators four times daily, oxygen therapy, and respiratory physiotherapy. Patients with purulent sputum additionally received antibiotics for 7 days according to their culture and susceptibility results.

On day 3, treatment success was comparable between the two groups, occurring in 90% of patients in the purulent group and 91% in the nonpurulent group.

After 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. There were no significant differences between the groups in other measures such as length of stay, exacerbation rate or re-admissions. However, patients in the purulent group were more likely to have another exacerbation within 180 days than those in the nonpurulent group.

Interestingly, the authors 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 authors, writing in the European Respiratory Journal, say their findings indicate that sputum purulence can be used to determine antibiotic use during emergency admissions for COPD. Additionally, CRP levels could give physicians confidence about the absence of bacterial infection.

On the basis of these results, they say they have begun a randomized, double-blind trial to confirm their findings.

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