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A Meta-analysis

Sanjay Saint, MD; Stephen Bent, MD; Eric Vittinghoff, PhD; Deborah Grady, MD, MPH

JAMA. 1995;273(12):957-960.

Abstract
Objective.
—A meta-analysis of randomized trials was performed to estimate the effectiveness of antibiotics in treating exacerbations of chronic obstructive pulmonary disease (COPD).

Data Sources.
—English-language studies published from 1955 through 1994 were retrieved using MEDLINE, Index Medicus, bibliographies, and consultation with experts. MEDLINE search terms included "COPD," "chronic bronchitis," and "antibiotic(s)."

Study Selection.
—Only randomized trials that enrolled patients having an exacerbation of COPD, used an antibiotic in the treatment group and placebo in the control group, and provided sufficient data to calculate an effect size were included in the meta-analysis.

Data Extraction.
—Descriptive and outcome data from each study were independently abstracted by two authors.

Data Synthesis.
—Overall summary effect size of the nine trials satisfying all inclusion criteria was 0.22 (95% confidence interval [CI], 0.10 to 0.34), indicating a small benefit in the antibiotic-treated group. Similar analysis of the six studies that provided data on peak expiratory flow rate changes revealed a summary effect size of 0.19 (95% CI, 0.03 to 0.35) and a summary change in peak expiratory flow rate of 10.75 L/min (95% CI, 4.96 to 16.54 L/min) in favor of the antibiotic-treated group. Sensitivity analyses did not significantly affect these results.

Conclusions.
—These analyses suggest a small but statistically significant improvement due to antibiotic therapy in patients with exacerbations of COPD. This antibiotic-associated improvement may be clinically significant, especially in patients with low baseline flow rates.

(JAMA. 1995;273:957-960)

Author Affiliations
From the Departments of Medicine (Drs Saint and Bent) and Epidemiology and Biostatistics (Dr Grady), University of California, San Francisco, School of Medicine; Medical Service, San Francisco Veterans Affairs Medical Center (Drs Saint, Bent, and Grady); and Department of Obstetrics and Gynecology and Reproductive Sciences, San Francisco General Hospital (Dr Vittinghoff).

Footnotes
Reprint requests to Veterans Affairs Medical Center (111A1), 4150 Clement St, San Francisco, CA 94105 (Dr Grady).

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