X.2.2.4 Combined systemic corticosteroids and antibiotics for treatment of exacerbation

A randomized placebo controlled trial (Daniels 2010) has provided evidence to support the traditional practice of treating acute exacerbations with a combination of systemic corticosteroids and antibiotics.  In this study, hospitalised patients were commenced on a tapering dose of prednisolone and randomised to receive doxycycline 200mg daily or placebo for 7 days.  Clinical cure, defined as complete resolution of signs and symptoms, at day 10 was significantly higher in the antibiotic treated group compared to placebo (OR 1.9, 95% CI 1.2 to 3.2, NNT = 7, 95% CI 4 to 523).  By day 30, the primary end point, there was no significant difference in clinical cure. Serious adverse effects occurred in 9% of the doxycycline group (7 deaths) and 5% of the placebo group (3 deaths).  Medication adverse events were similar between groups, 3% in the doxycycline group and 4% in the placebo.