Retrospective Analysis of Doxycycline or Bactrim Prophylaxis for Patients with Chronic Obstructive Pulmonary Disease

Background: Azithromycin prophylaxis has shown to decrease COPD exacerbations but led to hearing deficits. Therefore, there is a need to study other antibiotics as possible prophylaxis for COPD exacerbations. Objective: To evaluate the effectiveness of doxycycline or Bactrim prophylaxis for patients with moderate to severe COPD. Methods: We studied patients with moderate to severe COPD who were treated with prophylactic doxycycline or Bactrim in the fall and winter months along with their standard COPD therapy. From patient histories, we determined the number of exacerbations/year and hospitalizations/year prior to and after prophylaxis. Paired t-tests were used to analyze the data. Results: 17 patients with moderate to severe COPD on standard therapy were identified. Prophylactic doxycycline or Bactrim were added to their treatment regimens as a part of routine prophylaxis. Patients were on prophylaxis for a period of 6 months per year. The number of average exacerbations per year decreased from 4.44 ± 4.42 to 1.20 ± 1.0 (n=15, p=0.0047) and the number of hospitalizations per year decreased from 1.75 ± 1.12 to 0.00 ± 0 (n=5, p=0.0125). The number of exacerbations per person during the months with prophylaxis was 1.19 compared with 1.63 exacerbations per person during the months without prophylaxis (n=16, p=0.24). The antibiotics were well tolerated. Conclusion: This retrospective analysis showed a significant decrease in the number of exacerbations and hospitalizations per year for COPD patients undergoing doxycycline or Bactrim prophylaxis. This small study suggests the need for a prospective randomized study evaluating prophylactic doxycycline, Bactrim or other antibiotics in patients with moderate to severe COPD.