ACP Journal Club: review: antibiotics reduce treatment failure in acute chronic obstructive pulmonary disease exacerbations.

Commentary The meta-analysis by Vollenweider and colleagues finds that antibiotics reduce treatment failure in outpatients and inpatients alike, yet emphasizes a sensitivity analysis limited to currently used antibiotics that yielded similar relative risks but lacked power to demonstrate statistical significance. This sensitivity analysis seems somewhat arbitrary if antibiotic efficacy in COPD exacerbations can be attributed to bacterial killing, as seems most likely, and because it included some antibiotics no longer widely used for COPD due to changing antimicrobial resistance patterns. Moreover, in clinical practice, inpatient and outpatient exacerbations may be hard to distinguish objectively, as the threshold for hospital admission is influenced by clinician judgment and patient preferences.