{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T06:52:39Z","timestamp":1777531959258,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T00:00:00Z","timestamp":1513036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Chron Respir Dis"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:p>Asthma and chronic obstructive pulmonary disease (COPD) cause significant morbidity and mortality worldwide, primarily through exacerbations. Exacerbations are often treated with antibiotics but their optimal course duration is uncertain. Reducing antibiotic duration may influence antimicrobial resistance but risks treatment failure. The objective of this article is to review published literature to investigate whether shorter antibiotic therapy duration affects clinical outcomes in the treatment of asthma and COPD exacerbations. We systematically searched electronic databases (MEDLINE, EMBASE, CINAHL, World Health Organisation International Clinical Trial Registry Platform, the Cochrane library, and ISRCTN) with no language, location, or time restrictions. We retrieved observational and controlled trials comparing different durations of the same oral antibiotic therapy in the treatment of acute exacerbations of asthma or COPD in adults. We found no applicable studies for asthma exacerbations. We included 10 randomized, placebo-controlled trials for COPD patients, all from high-income countries. The commonest studied antibiotic class was fluoroquinolones. Antibiotic courses shorter than 6 days were associated with significantly fewer overall adverse events (risk ratio (RR): 0.84, 95% confidence interval (CI): 0.75\u20130.93, p = 0.001) when compared with those of 7 or more days. There was no statistically significant difference for clinical success or bacteriological eradication in sputum (RR: 1.00, 95% CI: 0.88\u20131.13 and RR: 1.06, 95% CI: 0.79\u20131.44, respectively). Shorter durations of antibiotics for COPD exacerbations do not seem to confer a higher risk of treatment failure but are associated with fewer adverse events. This is in keeping with previous studies in community acquired pneumonia, but studies were heterogeneous and differed from usual clinical practice. Further observational and prospective work is needed to explore the significance of antibiotic duration in the treatment of asthma and COPD exacerbations.<\/jats:p>","DOI":"10.1177\/1479972317745734","type":"journal-article","created":{"date-parts":[[2017,12,13]],"date-time":"2017-12-13T04:05:00Z","timestamp":1513137900000},"page":"225-240","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":25,"title":["Does antibiotic treatment duration affect the outcomes of exacerbations of asthma and COPD? A systematic review"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6091-9316","authenticated-orcid":false,"given":"Marie","family":"Stolbrink","sequence":"first","affiliation":[{"name":"Institute of Infection and Global Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Amiry","sequence":"additional","affiliation":[{"name":"Aintree University Hospital, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D","family":"Blakey","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK"},{"name":"Health Services Research Institute, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,12,12]]},"reference":[{"key":"bibr1-1479972317745734","unstructured":"Global Asthma Network. 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Chronic obstructive pulmonary disease: Costing report. https:\/\/www.nice.org.uk\/guidance\/cg101\/resources\/costing-report-134511805 (2011, accessed 11 January 2017)."},{"key":"bibr7-1479972317745734","first-page":"CD002741","volume":"3","author":"Graham V","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr8-1479972317745734","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61382-8"},{"key":"bibr9-1479972317745734","first-page":"CD010257","volume":"12","author":"Vollenweider DJ","year":"2012","journal-title":"Cochrane database Syst Rev"},{"key":"bibr10-1479972317745734","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.5664"},{"key":"bibr11-1479972317745734","unstructured":"British Thoracic Society. BTS\/SIGN British guideline on the management of asthma. https:\/\/www.brit-thoracic.org.uk\/standards-of-care\/guidelines\/btssign-british-guideline-on-the-management-of-asthma\/ (2016, accessed 11 January 2017)."},{"key":"bibr12-1479972317745734","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00167.x"},{"key":"bibr13-1479972317745734","unstructured":"WHO. Antimicrobial Resistance. Global Report on Surveillance. http:\/\/www.who.int\/drugresistance\/en\/ (2014, accessed 1 January 2017)."},{"key":"bibr14-1479972317745734","unstructured":"World Health Organization. Global action plan on antimicrobial resistance. http:\/\/www.who.int\/antimicrobial-resistance\/publications\/global-action-plan\/en\/ (2015, accessed 1 January 2017)."},{"key":"bibr15-1479972317745734","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e1567"},{"key":"bibr16-1479972317745734","unstructured":"Forum of International Respiratory Societies. 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