Therapy

• a second-generation cepaholsporin (e.g ceftibuten) ^a
• co-amoxiclav ^a
• a quinolone ^a
• a macrolide ^a

Why?

• These antibiotics are all equally effective at curing COPD exacerbations  ^a , although cephalosporins may cause fewer adverse effects than macrolides ^a

Ceftibuten causes fewer adverse effects than clarithromycin

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute exacerbation of COPD a	ceftibuten	clarithromycin	adverse effects at71 days	22%	76% (50% to 88%)	6 (4 to 11)

Note

• Fewer patients are cured on trimethoprim-sulphamethoxazole than ofloxacin. ^a

Trimethoprim-sulphamethoxazole cures fewer patients than ofloxacin

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute exacerbation of COPD a	ofloxacin	trimethoprim-sulphamethoxazole	cure at 14 days	52%	55% (22% to 96%)	4 (2 to 7)