Grade table 10

Question: Should antibiotics versus placebo be used in patients with acute COPD exacerbation?

Settings: LMICs

Bibliography: Ram FSF et al. (19)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsAntibioticsPlaceboRelative (95% CI)Absolute
Mortality (follow-up 10–14 days1; assessed with: number of patients died)
3randomised trialsno serious limitationsserious2serious3serious4reporting bias55/151 (3.3%)22/147 (15%)RR 0.24 (0.1 to 0.57)114 fewer per 1000 (from 64 fewer to 135 fewer)⊕○○○
VERY LOW		IMPORTANT
-1%8 fewer per 1000 (from 4 fewer to 9 fewer)
-60%456 fewer per 1000 (from 258 fewer to 540 fewer)
Treatment failure (hospital-based trials) (follow-up 6–18 days1; assessed with: patients failed treatment)
4randomised trialsno serious limitationsserious2serious3serious4reporting bias545/162 (27.8%)93/159 (58.5%)RR 0.47 (0.36 to 0.62)310 fewer per 1000 (from 222 fewer to 374 fewer)⊕○○○
VERY LOW		–
-21%111 fewer per 1000 (from 80 fewer to 134 fewer)
-100%530 fewer per 1000 (from 380 fewer to 640 fewer)
Treatment failure (hospital-based trials) (follow-up 6–18 days1; assessed with: patients failed treatment)
2randomised trialsno serious limitationsserious2serious3serious4reporting bias568/189 (36%)77/195 (39.5%)RR 0.91 (0.7 to 1.18)36 fewer per 1000 (from 118 fewer to 71 more)⊕○○○
VERY LOW		–
-21%-
Resolution of sputum purulence (follow-up 14–28 days; assessed with: number of patient with sputum purulence at the end of treatment)
2randomised trialsno serious limitationsserious2serious3serious4reporting bias332/104 (30.8%)60/101 (59.4%)RR 0.52 (0.37 to 0.72)285 fewer per 1000 (from 166 fewer to 374 fewer)⊕○○○
VERY LOW		–
-0%-
-87%418 fewer per 1000 (from 244 fewer to 548 fewer)
Adverse events (follow-up 10–28 days; assessed with: number of patients with adverse events)
2randomised trials6no serious limitationsserious2serious3serious4reporting bias530/136(22.1%)10/132 (7.6%)RR 2.91 (1.48 to 5.72)145 more per 1000 (from 36 more to 358 more)⊕○○○
VERY LOW		–
-7%134 more per 1000 (from 34 more to 330 more)
Diarrhoea (follow-up 8–10 days1; assessed with: number of patients with diarrhoea)
2randomised trialsno serious limitationsserious2serious3serious4reporting bias514/180 (7.8%)5/183 (2.7%)RR 2.86 (1.06 to 7.76)51 more per 1000 (from 2 more to 185 more)⊕○○○
VERY LOW		–
0%–
FEV1 (follow-up mean 7 days; measured with: litres; better indicated by higher values)
1randomised trialsno serious limitationsno serious inconsistencyserious3serious7reporting bias52020–MD 0.06 lower (0.34 lower to 0.22 higher)⊕○○○
VERY LOW		–
PEFR (follow-up 7–8 days1; measured with: litres per minute; better indicated by higher values)
3randomised trialsno serious limitationsserious2serious3serious4reporting bias5135150–MD 0.54 higher (22.57 lower to 23.64 higher)⊕○○○
VERY LOW		–
1

This is duration of treatment; duration of follow-up is not reported.

2

Substantial differences across the trials in patient population and types of antibiotic used.

3

Studies are not performed exclusively in patient population from LMICs.

4

Events rate and sample size are low in the included studies.

5

Literature search up to 2005.

6

Other studies not reported.

7

Small sample size.

From: Annex 4, Grade tables

Cover of Prevention and Control of Noncommunicable Diseases
Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings.
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