Improved outcomes with azithromycin vs beta-lactams for acute exacerbations of chronic obstructive pulmonary disease

Reference

Baalbaki N, Giuliano C, Hartner CL, Kale-Pradhan P, Johnson L. Azithromycin versus beta-lactams in hospitalized patients with acute exacerbations of COPD. J Gen Intern Med 2022;37(16):4183-4188.

Synopsis

These researchers compiled data on patients admitted for treatment of chronic obstructive pulmonary disease (COPD) from 6 hospitals in the United States. The researchers did not include patients who were admitted for treatment of pneumonia but did include patients who subsequently developed pneumonia during hospitalization. The cohort comprised 595 patients, of which 72% received azithromycin and 28% received a beta-lactam (ceftriaxone or cefuroxime in 92%). Treatment failure was defined as a composite of in-hospital mortality, admission to intensive care, need for mechanical ventilation, change in antibiotic, steroid therapy escalation, or readmission for COPD exacerbation within 30 days of discharge. Treatment successes occurred in 80.4% of patients treated with azithromycin but only 67.7% of patients treated with a beta-lactam (P < .01). The 2 largest contributors to this difference were the need for a new antibiotic treatment (12.6% vs 4.2%; P < .001) and higher readmission within 30 days (19.3% vs 12.4%; P = .032). This study is limited because it was not a randomized trial, was unmasked, and did not have a placebo control.