Narrow- vs broad-spectrum antibiotics: Which is better for older AECOPD patients?

Use of either empiric broad- or narrow-spectrum antibiotics in older patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) shows no remarkable difference in the primary outcome, reports a recent study.

The primary outcome is a composite of mechanical ventilation 48 hours after admission, transfer to the intensive care unit 48 hours after admission, 30-day COP) readmission, and oxygen saturation <90 percent on room air or increased oxygen requirements from baseline 48 hours after admission.

This multicentre, retrospective, cohort study sought to compare the outcomes of older patients receiving broad- versus narrow-spectrum antibiotics during hospitalization for AECOPD. A total of 253 inpatients aged ≥65 years with a primary discharge diagnosis of AECOPD who received ≥48 hours of antibiotic therapy were included in the analysis.

Subsequently, the researchers compared participants based on the spectrum of their antibiotic therapy. Narrow-spectrum antibiotics included azithromycin, doxycycline, sulfamethoxazole/trimethoprim, or aminopenicillin.

Of the patients, 127 were included in the narrow-spectrum group and 126 in the broad-spectrum group. Patient demographics and comorbid conditions were comparable in each cohort. The incidence of the primary composite outcome did not significantly differ between the two groups (narrow- vs broad spectrum: 50 [39.3 percent] vs 60 [47.6 percent]; p=0.19).

“No difference was found in the primary outcome in inpatients aged ≥65 years with AECOPD who received empiric broad-spectrum or narrow-spectrum antibiotics,” the researchers said.