{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:13:30Z","timestamp":1753892010338,"version":"3.41.2"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality. In some acute exacerbations of COPD (AECOPD) in patients with no obvious signs of infection, early antibiotic treatment seems to clinically improve the disease, but more studies are needed to determine the prognostic impact of antibiotic treatment in AECOPD patients with no obvious signs of infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To clarify the impact of antibiotic treatment on the short-term and long-term prognoses of AECOPD patients without obvious signs of infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The impact of the two treatment methods on the prognosis of patients was compared at 30, 90, 180, and 360\u00a0days after discharge. A multicenter, randomized, parallel-controlled clinical trial was conducted in a department of respiratory and critical care medicine in Central China. All patients met the inclusion criteria for AECOPD, and the patients were randomly assigned to the antibiotic group or the nonantibiotic group at a 1:1 ratio. Patients in the antibiotic group were given moxifloxacin 400\u00a0mg\/day intravenously for 7\u00a0days. Patients in the nonantibiotic group were intravenously injected with the same amount of normal saline as the amount of moxifloxacin given to those in the antibiotic group for 7\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 406 patients in the antibiotic group and 410 patients in the nonantibiotic group. During the short-term and long-term follow-ups, the acute exacerbation frequency, intensive care unit (ICU) treatment rate, mortality, and mMRC and CAT scores were not significantly different between the two groups (<jats:italic>p<\/jats:italic> &amp;gt; 0.05). At the 180- and 360-day follow-ups, the forced expiratory volume in 1\u00a0s (FEV1%) and peak expiratory flow (PEF) were not significantly different between the two groups (<jats:italic>p<\/jats:italic> &amp;gt; 0.05). The 30-day readmission rate was significantly lower in the antibiotic group than in the nonantibiotic group (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). The time from discharge to the first acute exacerbation was not significantly different between the two groups (<jats:italic>p<\/jats:italic> &amp;gt; 0.05). The length of the first hospital stay after discharge was significantly lower in the antibiotic group (5.84\u00a0days) than in the nonantibiotic group (6.75\u00a0days) (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). At the 30-day follow-up, the acute exacerbation frequency, age, C-reactive protein (CRP) level, and sputum viscosity were significantly greater in the nonantibiotic group than in the antibiotic group (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). In addition, according to the receiver operating characteristic (ROC) analysis, the frequency of acute exacerbations at the 30-day follow-up was significantly greater in COPD patients aged &amp;gt;62.5\u00a0years, with a CRP level &amp;gt;12.56\u00a0mg\/L or with a sputum viscosity &amp;gt;III, in the nonantibiotic group than in those in the antibiotic group, suggesting that the short-term prognosis was poor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients who are &amp;gt;62.5\u00a0years of age, have a CRP concentration &amp;gt;12.56\u00a0mg\/L, or have a sputum viscosity &amp;gt;III without obvious signs of infection should be treated with antibiotics to improve their short-term prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration:<\/jats:title><jats:p>(<jats:ext-link>https:\/\/www.chictr.org.cn<\/jats:ext-link>), (ChiCTR1800018921)<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2024.1380939","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T05:05:06Z","timestamp":1715317506000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The use of antibiotics in the early stage of acute exacerbation of chronic obstructive pulmonary disease in patients without obvious signs of infection: a multicenter, randomized, parallel-controlled study"],"prefix":"10.3389","volume":"15","author":[{"given":"Ling","family":"Zhou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiguo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1001\/jama.2018.17933","article-title":"Effect of a Program combining transitional care and long-term self-management support on outcomes of hospitalized patients with chronic obstructive pulmonary disease: a randomized clinical trial","volume":"320","author":"Aboumatar","year":"2018","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e21152","DOI":"10.1097\/MD.0000000000021152","article-title":"C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations: a protocol for systematic review and meta-analysis","volume":"99","author":"An","year":"2020","journal-title":"Med. Baltim."},{"key":"B3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1056\/NEJMoa1803185","article-title":"C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations","volume":"381","author":"Butler","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1586\/17476348.2015.1067608","article-title":"Assessment of pulmonary rehabilitation efficacy in chronic obstructive pulmonary disease patients using the chronic obstructive pulmonary disease assessment test","volume":"9","author":"Candemir","year":"2015","journal-title":"Expert Rev. Respir. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1590\/s1806-37132014000500005","article-title":"Utility of the combination of serum highly-sensitive C-reactive protein level at discharge and a risk index in predicting readmission for acute exacerbation of COPD","volume":"40","author":"Chang","year":"2014","journal-title":"J. Bras. Pneumol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.jfma.2018.06.018","article-title":"Comparison between COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scores for evaluation of clinical symptoms, comorbidities and medical resources utilization in COPD patients","volume":"118","author":"Cheng","year":"2019","journal-title":"J. Formos. Med. Assoc."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.2147\/COPD.S207626","article-title":"Statistical process control improves the feasibility of remote physiological monitoring in patients with chronic obstructive pulmonary disease","volume":"14","author":"Cooper","year":"2019","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s11739-020-02420-1","article-title":"Age is a determinant of short-term mortality in patients hospitalized for an acute exacerbation of COPD","volume":"16","author":"Crisafulli","year":"2020","journal-title":"Intern Emerg. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"445","DOI":"10.2147\/COPD.S93398","article-title":"Bacterial-viral load and the immune response in stable and exacerbated COPD: significance and therapeutic prospects","volume":"11","author":"D'Anna","year":"2016","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.pupt.2011.08.004","article-title":"Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease","volume":"25","author":"Dimopoulos","year":"2012","journal-title":"Pulm. Pharmacol. Ther."},{"key":"B11","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1136\/thoraxjnl-2019-214168","article-title":"Sputum microbiome profiling in COPD: beyond singular pathogen detection","volume":"75","author":"Ditz","year":"2020","journal-title":"Thorax"},{"key":"B12","doi-asserted-by":"publisher","first-page":"413","DOI":"10.7326\/M19-3007","article-title":"Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis","volume":"172","author":"Dobler","year":"2020","journal-title":"Ann. Intern Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2304","DOI":"10.1056\/NEJMoa1908142","article-title":"Metoprolol for the prevention of acute exacerbations of COPD","volume":"381","author":"Dransfield","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3892\/etm.2017.4496","article-title":"The levels of serum pro-calcitonin and high-sensitivity C-reactive protein in the early diagnosis of chronic obstructive pulmonary disease during acute exacerbation","volume":"14","author":"Gao","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1055\/s-0040-1708837","article-title":"Chronic obstructive pulmonary disease in the intensive care unit: antibiotic treatment of severe chronic obstructive pulmonary disease exacerbations","volume":"41","author":"Gupta","year":"2020","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/QCO.0000000000000533","article-title":"Acute exacerbations in chronic obstructive pulmonary disease: should we use antibiotics and if so, which ones?","volume":"32","author":"Jacobs","year":"2019","journal-title":"Curr. Opin. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.micpath.2017.10.021","article-title":"Worldwide prevalence of viral infection in AECOPD patients: a meta-analysis","volume":"113","author":"Jafarinejad","year":"2017","journal-title":"Microb. Pathog."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1753466620961688","DOI":"10.1177\/1753466620961688","article-title":"Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease","volume":"14","author":"Jo","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1183\/09031936.00102509","article-title":"Development and first validation of the COPD assessment test","volume":"34","author":"Jones","year":"2009","journal-title":"Eur. Respir. J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1801261","DOI":"10.1183\/13993003.01261-2018","article-title":"What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement","volume":"52","author":"Kim","year":"2018","journal-title":"Eur. Respir. J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.immuni.2019.03.018","article-title":"The cytokines of Asthma","volume":"50","author":"Lambrecht","year":"2019","journal-title":"Immunity"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1093\/ajhp\/zxaa317","article-title":"Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation","volume":"78","author":"Lancaster","year":"2020","journal-title":"Am. J. Health Syst. Pharm."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0124374","DOI":"10.1371\/journal.pone.0124374","article-title":"Antibiotic prescription for COPD exacerbations admitted to hospital: European COPD audit","volume":"10","author":"L\u00f3pez-Campos","year":"2015","journal-title":"PLoS One"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.rmed.2011.02.003","article-title":"Cough and sputum production as risk factors for poor outcomes in patients with COPD","volume":"105","author":"Miravitlles","year":"2011","journal-title":"Respir. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1164\/rccm.201302-0289PP","article-title":"Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease","volume":"188","author":"Miravitlles","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"15","DOI":"10.2169\/internalmedicine.55.4490","article-title":"Evaluation of the modified medical research council dyspnea scale for predicting hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease","volume":"55","author":"Natori","year":"2016","journal-title":"Intern Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"551","DOI":"10.2147\/COPD.S62104","article-title":"Real-world characterization and differentiation of the global initiative for chronic obstructive lung disease strategy classification","volume":"9","author":"Price","year":"2014","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"B28","first-page":"e253","article-title":"Association between length of stay and readmission for COPD","volume":"23","author":"Rinne","year":"2017","journal-title":"Am. J. Manag. Care"},{"key":"B29","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1136\/thx.2008.095349","article-title":"Antibiotic treatment is associated with reduced risk of a subsequent exacerbation in obstructive lung disease: an historical population based cohort study","volume":"63","author":"Roede","year":"2008","journal-title":"Thorax"},{"key":"B30","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/j.1469-0691.2006.01638.x","article-title":"Three vs. 10 days of amoxycillin-clavulanic acid for type 1 acute exacerbations of chronic obstructive pulmonary disease: a randomised, double-blind study","volume":"13","author":"Roede","year":"2007","journal-title":"Clin. Microbiol. Infect."},{"key":"B31","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1183\/09031936.00088108","article-title":"Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD","volume":"33","author":"Roede","year":"2009","journal-title":"Eur. Respir. J."},{"key":"B32","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1164\/rccm.202004-0896ED","article-title":"Antibiotic retreatment for acute exacerbations of chronic obstructive pulmonary disease","volume":"202","author":"Sethi","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"399","DOI":"10.2147\/COPD.S144312","article-title":"Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition)","volume":"13","author":"Shen","year":"2018","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2885","DOI":"10.2147\/COPD.S225365","article-title":"Serum alpha-1 antitrypsin levels and the clinical course of chronic obstructive pulmonary disease","volume":"14","author":"Takei","year":"2019","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"B35","doi-asserted-by":"publisher","first-page":"Cd010257","DOI":"10.1002\/14651858.CD010257.pub2","article-title":"Antibiotics for exacerbations of chronic obstructive pulmonary disease","volume":"10","author":"Vollenweider","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"B36","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1186\/s12879-020-05313-y","article-title":"The sputum microbiome associated with different sub-types of AECOPD in a Chinese cohort","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Infect. Dis."},{"key":"B37","doi-asserted-by":"publisher","first-page":"883","DOI":"10.2147\/JAA.S312361","article-title":"Small-airway dysfunction is involved in the pathogenesis of Asthma: evidence from two mouse models","volume":"14","author":"Xue","year":"2021","journal-title":"J. Asthma Allergy"},{"key":"B38","doi-asserted-by":"publisher","first-page":"328","DOI":"10.5578\/tt.20219705","article-title":"Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease","volume":"69","author":"Y\u0131lmaz","year":"2021","journal-title":"Tuberk. Toraks"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e10","DOI":"10.3346\/jkms.2020.35.e10","article-title":"Clinical role of the chronic obstructive pulmonary disease assessment test in prediction of the response to treatment for exacerbations","volume":"35","author":"Yoon","year":"2020","journal-title":"J. Korean Med. Sci."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1341644","DOI":"10.1155\/2021\/1341644","article-title":"Tiotropium bromide attenuates mucus hypersecretion in patients with stable chronic obstructive pulmonary disease","volume":"2021","author":"Yu","year":"2021","journal-title":"Comput. Math. Methods Med."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1380939\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T05:05:09Z","timestamp":1715317509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1380939\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,10]]},"references-count":40,"alternative-id":["10.3389\/fphar.2024.1380939"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2024.1380939","relation":{},"ISSN":["1663-9812"],"issn-type":[{"type":"electronic","value":"1663-9812"}],"subject":[],"published":{"date-parts":[[2024,5,10]]},"article-number":"1380939"}}