Use of continuous prophylactic antibiotics results in a clinically significant benefit in reducing exacerbations in COPD patients. All trials of continuous antibiotics used macrolides hence the noted benefit applies only to the use of continuous macrolide antibiotics. The impact of pulsed antibiotics remains uncertain and requires further trials in this review included patients who were frequent exacerbators and needed treatment with antibiotics or systemic steroids, or who were on supplemental oxygen. There were also older individuals with a mean age of 66 years. The results of these trials apply only to the group of patients who were studied in these trials and may not be generalisable to other of concerns about antibiotic resistance and specific adverse effects, consideration of prophylactic antibiotic use should be mindful of the balance between benefits to individual patients and the potential harms to society created by antibiotic overuse.
The Cochrane review as well as the recent meta-analysis (5) both
suggest that parenteral steroids have a prophylactic role in adult
patients. Since there is no evidence of efficacy in the pediatric age
group, pediatricians are left to make their own choices. However, it
should be noted that "absence of evidence of efficacy" is not synonymous
with "evidence of absence of efficacy". Using these arguments, I noted
earlier this year(6)that going strictly by the principles of evidence
based medicine, there is nothing to warrant a change from existing
practice in individual pediatric and neonatal intensive care units.
However it may be possible that multiple doses of steroids, administered
at least 12 hours prior to extubation is beneficial in children as well.
The answer can only be provided through an appropriate randomised