P4. Antibiotics

Current evidence does not support long-term antibiotic use to prevent exacerbations in patients with COPD (Isada CM and Stoller JK, 1994),(Siafakas NM and Bouros D, 1998) [evi­dence level I]. However, they should be used in exacerba­tions with an increase in cough, dyspnoea, sputum volume or purulence (see section X).

Prophylactic antibiotics in chronic bronchitis/ COPD have a small but statistically significant effect in reducing the days of illness due to exacerbations of chronic bronchitis. However, they do not have a place in routine treatment because of concerns about the development of antibiotic resistance and the possibility of adverse effects. The available data are over 30 years old, so the pattern of antibiotic sensitivity may have changed and there is a wider range of antibiotics in use. (Black et al., 2003) A recent 12 month randomised controlled trial of erythromycin 250mg bd in patients with moderate COPD found a significantly reduced risk of exacerbation with a rate ratio of 0.65 (95%CI 0.49-0.86) (Seemungal et al., 2008) [evidence level II].