Supplementary Material for: Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

Background: Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. Objectives: This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. Methods: A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. Results: Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. Conclusion: Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.

背景：尽管对于慢性阻塞性肺疾病急性加重（AECOPD）的治疗推荐使用抗生素，但在实际应用场景中的价值仍存在争议。研究目的：本研究旨在评估抗生素治疗对AECOPD患者的短期及长期效果。研究方法：本研究在PharmLines倡议下进行了一项队列研究。我们纳入了首次记录诊断为COPD且因AECOPD发作接受系统性糖皮质激素治疗的参与者。暴露组和参照组基于AECOPD治疗期间是否开具抗生素处方进行定义。短期结局为自基准日期起14至30天内AECOPD治疗失败。长期结局为下一次加重的时间。使用倾向评分对混杂因素进行调整。结果：在1,105例AECOPD患者中，518例（46.9%）的患者接受了抗生素处方，而587例（53.1%）的患者未接受抗生素治疗。总体而言，与参照组相比，抗生素的使用与AECOPD治疗失败的相对风险降低37%相关（调整后的优势比[aOR]为0.63 [95% CI: 0.40–0.99]）。多西环素、大环内酯和复方阿莫西林对保护作用相似，尽管只有多西环素的效果具有统计学意义（aOR 0.53 [95% CI: 0.28–0.99]）。阿莫西林未观察到保护作用（aOR 1.49 [95% CI: 0.78–2.84]）。两组患者下一次加重的风险和时间相似。结论：总体而言，在现实世界的门诊环境中，抗生素治疗，尤其是多西环素，与系统性糖皮质激素的联合使用可降低AECOPD的短期治疗失败率。对于预防后续加重，未发现抗生素治疗对AECOPD的长期有益效果。