It's unknown whether treatment with antibiotics and systemic corticosteroids is beneficial for all patients having exacerbations of chronic obstructive pulmonary disease (COPD), especially for those experiencing mild exacerbations and treated in the outpatient setting. Researchers conducted a systematic review to evaluate the effect of pharmacological interventions on health outcomes and adverse events in adults with mild, moderate, and severe exacerbations of COPD.

A total of 68 randomized controlled trials with 10,758 participants who had exacerbations of COPD were included in the analysis. Patients were treated in both in- and outpatient settings but not in the ICU.

Compared with placebo or management without antibiotics, the use of antibiotics was associated with increased exacerbation resolution and less treatment failure at the end of intervention, independent of exacerbation severity and treatment setting. Similarly, compared with placebo or management without systemic corticosteroids, the use of systemic corticosteroids was associated with less treatment failure at the end of intervention, independent of exacerbation severity and treatment setting. These medications, however, were associated with an increased number of total adverse events and endocrine-related adverse events. There was either insufficient evidence or no evidence supporting the use of other pharmacological treatments or informing the choice of antibiotic or corticosteroid treatment regimens.

The authors caution that there was only limited evidence for the main outcomes of interest in this study. In addition, they note, adverse events weren't reported in about one-third of the studies. Finally, most studies included hospitalized patients who had moderate-to-severe COPD exacerbations and none occurred in the ICU setting, so the results may not apply to outpatients who have milder exacerbations or to the sickest patients.