Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD

Background: COPD is a complex disease with exacerbations characterized by worsening of symptoms resulting in deteriorating lung function. Study objective: To assess predictive factors of relapse for patients with acute exacerbations of COPD (AECB). Design: Retrospective cohort analysis of visits for AECB. Setting: Veterans Affairs Medical Center. Patients: Three hundred sixty-two visits (173 patients) with documented COPD treated as outpatients for AECB. Measurements: Severity of underlying COPD, severity of AECB, comorbid conditions, therapy, and relapse rates (return visit within 14 days with persistent or worsening symptoms). Results: Each visit was analyzed individually (referred to as a patient-visit). One group received antibiotics (270 patient-visits), and the second group (92 patient-visits) did not. Both groups had similar demographics and severity of underlying COPD. The overall relapse rate was 22%. The majority of patient-visits (95%) with severe symptoms at presentation were prescribed antibiotics vs only 40% of those with mild symptoms. Twenty-nine of 92 patient-visits (32%) were followed by relapse in the group that was not given antibiotics, whereas only 50 of 270 (19%) treated with antibiotics relapsed (p < 0.001). Those treated with amoxicillin had an even higher relapse rate (20 of 37 patient-visits, or 54%) than those who did not receive antibiotics (p = 0.006). Conclusions: Relapse from AECB was not related to the severity of underlying disease or to the severity of the acute exacerbation. Patients treated with antibiotics had significantly lower relapse rates than those who did not receive antibiotics. However, the specific choice of antibiotic is important because those treated with amoxicillin had the highest relapse rates of all groups.