%0 Journal Article
%T Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review
%A Milo A Puhan
%A Daniela Vollenweider
%A Johann Steurer
%A Patrick M Bossuyt
%A Gerben ter Riet
%J BMC Medicine
%D 2008
%I BioMed Central
%R 10.1186/1741-7015-6-28
%X We conducted a historical systematic review. Through electronic databases and hand-searches, we identified placebo-controlled and head-to-head antibiotic trials for the treatment of mild to moderate chronic obstructive pulmonary disease exacerbations. We compared the numbers of patients recruited in placebo-controlled and head-to-head trials between 1957 and 2005. Using cumulative meta-analysis of placebo-controlled trials, we determined when, if ever, placebo-controlled trials had shown convincing evidence that antibiotics are effective in preventing treatment failure in patients with mild to moderate chronic obstructive pulmonary disease exacerbations.The first head-to-head trial was published in 1963. It was followed by another 100 trials comparing different antibiotics in a total of 34,029 patients with mild to moderate chronic obstructive pulmonary disease exacerbations. Over time, the cumulative odds ratio in placebo-controlled trials remained inconclusive throughout with odds ratios ranging from 0.39 (95% confidence intervals 0.04¨C4.22) to the most recent estimate (1995) of 0.81 (95% confidence intervals 0.52¨C1.28, P = 0.37).Placebo-controlled trials do not support the use of antibiotics in chronic obstructive pulmonary disease patients with mild to moderate exacerbations. Conducting head-to-head trials is, therefore, scientifically and ethically questionable. This underscores the requirement to perform or study systematic reviews of placebo-controlled trials before conducting head-to-head trials.The Helsinki Declaration emphasises the great importance of conducting experimental studies for medical progress. However, it also states that one should be very careful before embarking on randomised trials with placebo controls because research participants have a right to the best available treatment [1]. Worries about the 'unethical use of placebo' continue [2,3]. However, what about the reverse scenario? Might there be cases where experimental treatment did not
%U http://www.biomedcentral.com/1741-7015/6/28