{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:40:56Z","timestamp":1781790056139,"version":"3.54.5"},"reference-count":49,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Chronic obstructive pulmonary disease (COPD) is a global health problem and the third leading contributor to mortality worldwide. This systematic review aims to summarize the results of previous studies tackling the question of the efficacy of long-term prophylaxis of antibiotics in COPD patients, with particular regard to exacerbation rate, time to first exacerbation, health status, airway bacterial load, inflammatory markers, cell counts in sputum samples, and potential adverse events. Results: Four studies found significant improvement in the exacerbation rate in patients receiving antibiotic intervention. One study found doxycycline to have negative effects on patients\u2019 exacerbation outcomes. Two studies recorded a reduction in total airway bacterial load using quantitative culture of sputum samples, but the prevalence of antibiotic-resistant bacteria increased in all studies that measured it. No change in inflammatory markers was observed; however, there was a decline in neutrophil cell counts and, subsequently, reductions in neutrophil elastase concentrations. Methods: PubMed and Web of Science databases were searched for English-language studies presenting data on the prophylactic use of antibiotics in COPD management. All included studies are randomized controlled trials (RCTs) and meet the inclusion criteria. Conclusions: Based on current evidence from RCTs, the prophylactic antibiotic approach utilizing macrolides is the most effective in reducing the incidence of COPD exacerbation. However, the emergence of antibiotic-resistant pathogens is notable. Whether the beneficial effects of macrolides on exacerbation are due to their antibacterial or immunomodulant properties is still inconclusive. Future studies are needed to better understand the interactions between antibiotics and the airway microbiome during COPD exacerbation.<\/jats:p>","DOI":"10.3390\/antibiotics13121110","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T04:46:11Z","timestamp":1732164371000},"page":"1110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of Prophylactic Antibiotics in COPD: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5786-6198","authenticated-orcid":false,"given":"Anh Tuan","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Integrative Health Sciences, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0593-0188","authenticated-orcid":false,"given":"Amr Sayed","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5066-0646","authenticated-orcid":false,"given":"Marianna","family":"M\u00f3r\u00e9","sequence":"additional","affiliation":[{"name":"Department of Gerontology, Institute of Social and Sociological Sciences, Faculty of Health Sciences, University of Debrecen, 4400 Ny\u00edregyh\u00e1za, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0554-7350","authenticated-orcid":false,"given":"Attila Csaba","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6811-0113","authenticated-orcid":false,"given":"\u00c1gnes","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"Department of Integrative Health Sciences, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"ref_1","unstructured":"(2024, July 04). 2023 GOLD Report. Available online: https:\/\/goldcopd.org\/2023-gold-report-2\/."},{"key":"ref_2","unstructured":"(2024, July 04). Tobacco and Chronic Obstructive Pulmonary Disease (COPD). Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240084452."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(11)60968-9","article-title":"Chronic Obstructive Pulmonary Disease","volume":"379","author":"Decramer","year":"2012","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"457","DOI":"10.2147\/COPD.S32330","article-title":"Epidemiology of Chronic Obstructive Pulmonary Disease: A Literature Review","volume":"7","author":"Rycroft","year":"2012","journal-title":"COPD"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1016\/S0140-6736(05)66781-5","article-title":"Alpha1-Antitrypsin Deficiency","volume":"365","author":"Stoller","year":"2005","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3079","DOI":"10.2147\/COPD.S122282","article-title":"Major Air Pollutants and Risk of COPD Exacerbations: A Systematic Review and Meta-Analysis","volume":"11","author":"Li","year":"2016","journal-title":"Int. J. Chron. Obs. Pulmon. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1164\/rccm.202204-0671PP","article-title":"Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision","volume":"206","author":"Celli","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","unstructured":"(2024, July 04). COPD Causes-Occupations and Substances, Available online: https:\/\/www.hse.gov.uk\/copd\/causes.htm#occupations."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"(2003). American Thoracic Society Statement. Am. J. Respir. Crit. Care Med., 167, 787\u2013797.","DOI":"10.1164\/rccm.167.5.787"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jaci.2016.05.011","article-title":"Inflammatory Mechanisms in Patients with Chronic Obstructive Pulmonary Disease","volume":"138","author":"Barnes","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1164\/ajrccm.160.supplement_1.13","article-title":"Neutrophils and Protease\/Antiprotease Imbalance","volume":"160","author":"Stockley","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1152\/japplphysiol.00085.2009","article-title":"Ventilation-Perfusion Imbalance and Chronic Obstructive Pulmonary Disease Staging Severity","volume":"106","author":"Drakulovic","year":"2009","journal-title":"J. Appl. Physiol."},{"key":"ref_13","first-page":"414","article-title":"C-Reactive Protein Levels Are Raised in Stable Chronic Obstructive Pulmonary Disease Patients Independent of Smoking Behavior and Biomass Exposure","volume":"5","author":"Aksu","year":"2013","journal-title":"J. Thorac. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2147\/COPD.S13826","article-title":"Association between Lung Function and Exacerbation Frequency in Patients with COPD","volume":"5","author":"Hoogendoorn","year":"2010","journal-title":"Int. J. Chron. Obs. Pulmon. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.2147\/COPD.S306916","article-title":"Incidence and Prognostic Factors of Respiratory Viral Infections in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease","volume":"16","author":"Jang","year":"2021","journal-title":"Int. J. Chron. Obs. Pulmon. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1164\/rccm.200506-859OC","article-title":"Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations","volume":"173","author":"Papi","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_17","first-page":"CD002733","article-title":"Influenza Vaccine for Chronic Obstructive Pulmonary Disease (COPD)","volume":"6","author":"Kopsaftis","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1164\/rccm.201111-1933ED","article-title":"Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: \u201cDon\u2019t Think Twice, It\u2019s Alright!\u201d","volume":"185","author":"Elliott","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1001\/jamainternmed.2014.5430","article-title":"Outcomes Associated with Invasive and Noninvasive Ventilation among Patients Hospitalized with Exacerbations of Chronic Obstructive Pulmonary Disease","volume":"174","author":"Lindenauer","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1016\/j.athoracsur.2019.11.018","article-title":"Lung Volume Reduction Surgery: Reinterpreted with Longitudinal Data Analyses Methodology","volume":"109","author":"Lim","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1164\/rccm.200708-1283OC","article-title":"Determinants of the Survival Benefit of Lung Transplantation in Patients with Chronic Obstructive Pulmonary Disease","volume":"177","author":"Thabut","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_22","first-page":"703","article-title":"Pharmacological Management and Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease in Hospitalized Patients","volume":"41","author":"Dixit","year":"2016","journal-title":"Pharm. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1080\/15412555.2021.2000957","article-title":"Prevalence, Pattern, Risks Factors and Consequences of Antibiotic Resistance in COPD: A Systematic Review","volume":"18","author":"Smith","year":"2021","journal-title":"COPD"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.2147\/COPD.S371958","article-title":"The Microbiome in COPD: Emerging Potential for Microbiome-Targeted Interventions","volume":"17","author":"Millares","year":"2022","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e001335","DOI":"10.1136\/bmjresp-2022-001335","article-title":"Impact of Prophylactic and \u201crescue Pack\u201d Antibiotics on the Airway Microbiome in Chronic Lung Disease","volume":"10","author":"Rofael","year":"2023","journal-title":"BMJ Open Respir. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1056\/NEJMoa1104623","article-title":"Azithromycin for Prevention of Exacerbations of COPD","volume":"365","author":"Albert","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1164\/rccm.202212-2287OC","article-title":"A Double-Blind, Randomized, Placebo-Controlled Trial of Long-Term Doxycycline Therapy on Exacerbation Rate in Patients with Stable Chronic Obstructive Pulmonary Disease","volume":"208","author":"Allinson","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.rmed.2004.06.009","article-title":"The Effect of Oral Clarithromycin on Health Status and Sputum Bacteriology in Stable COPD","volume":"99","author":"Banerjee","year":"2005","journal-title":"Respir. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/1465-9921-14-125","article-title":"Azithromycin and Cough-Specific Health Status in Patients with Chronic Obstructive Pulmonary Disease and Chronic Cough: A Randomised Controlled Trial","volume":"14","author":"Berkhof","year":"2013","journal-title":"Respir. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1136\/thoraxjnl-2015-207194","article-title":"Effects of Different Antibiotic Classes on Airway Bacteria in Stable COPD Using Culture and Molecular Techniques: A Randomised Controlled Trial","volume":"70","author":"Brill","year":"2015","journal-title":"Thorax"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1164\/rccm.201402-0207OC","article-title":"Predictors of Chronic Obstructive Pulmonary Disease Exacerbation Reduction in Response to Daily Azithromycin Therapy","volume":"189","author":"Han","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1159\/000321374","article-title":"Effect of 6 Months of Erythromycin Treatment on Inflammatory Cells in Induced Sputum and Exacerbations in Chronic Obstructive Pulmonary Disease","volume":"80","author":"He","year":"2010","journal-title":"Respiration"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1164\/rccm.200801-145OC","article-title":"Long-Term Erythromycin Therapy Is Associated with Decreased Chronic Obstructive Pulmonary Disease Exacerbations","volume":"178","author":"Seemungal","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1465-9921-11-10","article-title":"PULSE Study Group Pulsed Moxifloxacin for the Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial","volume":"11","author":"Sethi","year":"2010","journal-title":"Respir. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Shafuddin, E., Mills, G.D., Holmes, M.D., Poole, P.J., Mullins, P.R., and Black, P.N. (2015). A Double-Blind, Randomised, Placebo-Controlled Study of Roxithromycin and Doxycycline Combination, Roxithromycin Alone, or Matching Placebo for 12 Weeks in Adults with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease. J. Negat. Results Biomed., 14.","DOI":"10.1186\/s12952-015-0034-8"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Simpson, J.L., Powell, H., Baines, K.J., Milne, D., Coxson, H.O., Hansbro, P.M., and Gibson, P.G. (2014). The Effect of Azithromycin in Adults with Stable Neutrophilic COPD: A Double Blind Randomised, Placebo Controlled Trial. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0105609"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4173962","DOI":"10.1155\/2016\/4173962","article-title":"Effects of Low-Dose and Long-Term Treatment with Erythromycin on Interleukin-17 and Interleukin-23 in Peripheral Blood and Induced Sputum in Patients with Stable Chronic Obstructive Pulmonary Disease","volume":"2016","author":"Tan","year":"2016","journal-title":"Mediat. Inflamm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S2213-2600(14)70019-0","article-title":"Azithromycin Maintenance Treatment in Patients with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease (COLUMBUS): A Randomised, Double-Blind, Placebo-Controlled Trial","volume":"2","author":"Uzun","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1164\/ajrccm.161.5.9908022","article-title":"Time Course and Recovery of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease","volume":"161","author":"Seemungal","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1136\/jcp.48.8.719","article-title":"Simple Method for Quantifying Viable Bacterial Numbers in Sputum","volume":"48","author":"Pye","year":"1995","journal-title":"J. Clin. Pathol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1038\/nrmicro1265","article-title":"The Bacterial Ribosome as a Target for Antibiotics","volume":"3","author":"Poehlsgaard","year":"2005","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/j.1574-6968.2008.01145.x","article-title":"Update on Macrolide-Lincosamide-Streptogramin, Ketolide, and Oxazolidinone Resistance Genes","volume":"282","author":"Roberts","year":"2008","journal-title":"FEMS Microbiol. Lett."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Sharkey, L.K.R., Edwards, T.A., and O\u2019Neill, A.J. (2016). ABC-F Proteins Mediate Antibiotic Resistance through Ribosomal Protection. mBio, 7.","DOI":"10.1128\/mBio.01975-15"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Golkar, T., Zieli\u0144ski, M., and Berghuis, A.M. (2018). Look and Outlook on Enzyme-Mediated Macrolide Resistance. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01942"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1099\/jmm.0.000475","article-title":"Mechanisms of Quinolone Action and Resistance: Where Do We Stand?","volume":"66","author":"Correia","year":"2017","journal-title":"J. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Markley, J.L., and Wencewicz, T.A. (2018). Tetracycline-Inactivating Enzymes. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01058"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102095","DOI":"10.1016\/j.pupt.2021.102095","article-title":"The Immunomodulatory Effects of Macrolide Antibiotics in Respiratory Disease","volume":"71","author":"Pollock","year":"2021","journal-title":"Pulm. Pharmacol. Ther."},{"key":"ref_48","first-page":"105","article-title":"Macrolide Antibacterials. Drug Interactions of Clinical Significance","volume":"13","author":"Adam","year":"1995","journal-title":"Drug Saf."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"174191","DOI":"10.1016\/j.ejphar.2021.174191","article-title":"Azithromycin: Immunomodulatory and Antiviral Properties for SARS-CoV-2 Infection","volume":"905","author":"Khezri","year":"2021","journal-title":"Eur. J. Pharmacol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/12\/1110\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:36:31Z","timestamp":1760114191000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/12\/1110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":49,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["antibiotics13121110"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13121110","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,21]]}}}