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COPDCDANCT07708337

Evaluating Customized Antibiotic Duration (CDA) Strategy in Acute Exacerbations of COPD

A study testing 7-day antibiotic course and 14-day antibiotic course in people with COPD and Acute Exacerbation of COPD, run by Capital Development Authority (CDA) at 1 site in Pakistan.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn whether a shorter course of antibiotics (7 days) works as well as the usual longer course (14 days) for adults admitted to hospital with a flare-up of chronic obstructive pulmonary disease (COPD), a long-term lung disease. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
COPD, Acute Exacerbation of COPD
What is being tested?
7-day antibiotic course and 14-day antibiotic course
Could I receive a placebo?
No, everyone receives an active treatment
How many people
560 participants
Where
1 sitePakistan
Study dates
26 Oct 2026to 28 Feb 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 18 years or older.
  • Physician-diagnosed COPD, confirmed by post-bronchodilator spirometry (FEV1/FVC < 0.70) where available, or by documented previous spirometry consistent with COPD.
  • A current acute exacerbation of COPD for which the treating physician judges antibiotic therapy to be necessary, with at least two of the three cardinal symptoms (increased dyspnoea, increased sputum volume, increased sputum purulence).
  • Able and willing to give written informed consent and to follow the study procedures and follow-up schedule.

Who cannot join

  • A documented infection that requires a defined, longer antibiotic course, such as pneumonia with complications, an exacerbation of bronchiectasis, lung abscess or empyema.
  • Need for immediate admission to intensive care or for invasive mechanical ventilation at presentation.
  • Severe immunosuppression, for example neutropenia, active malignancy under chemotherapy, organ transplantation or advanced HIV infection.
  • Suspected or confirmed pulmonary tuberculosis, or another respiratory infection that needs a different antimicrobial approach.
  • Pregnancy or breastfeeding.
  • Previous enrolment in this trial, or current participation in another interventional trial in AECOPD.
  • Systemic antibiotic treatment for the current exacerbation started more than 48 hours before randomisation.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Fazal Rabbi, MD contact

+923035646227

faiz@bjmu.edu.cn

Pakistan1 site
  • CDA Hospital Islamabad

    Islamabad, Pakistan, 44000

    Dr Fazal Rabbi, +923035646227, faiz@bjmu.edu.cn

Other trials in Pakistan

About this study

Official title: Evaluating Customized Antibiotic Duration (CDA) Strategy in Acute Exacerbations of COPD: Protocol for Randomized Controlled Trial

The goal of this clinical trial is to learn whether a shorter course of antibiotics (7 days) works as well as the usual longer course (14 days) for adults admitted to hospital with a flare-up of chronic obstructive pulmonary disease (COPD), a long-term lung disease. The trial takes place at CDA Hospital Islamabad, Pakistan.

The main questions it aims to answer are:

Read more
  • Do patients who take antibiotics for 7 days recover as well by Day 30 as patients who take them for 14 days?
  • Does the shorter course lead to fewer side effects and less antibiotic use, without more treatment failures, relapses or hospital readmissions? Researchers will compare a 7-day antibiotic course with the usual 14-day course to see if the shorter course is just as effective.

Participants will:

  • Be assigned by chance (like flipping a coin) to take antibiotics for either 7 days or 14 days. Their doctor chooses which antibiotic to use.
  • Receive all other usual hospital care for their COPD flare-up.
  • Have check-ups about 3-5 days, 7 days, 14 days and 30 days after joining the trial, in hospital or by telephone, to record their symptoms, any side effects and any return to hospital.

About 560 adults will take part.

Read the detailed description

Background: Antibiotics are routinely given to adults hospitalised with an acute exacerbation of COPD (AECOPD). International guidance (GOLD) advises that treatment should normally last about 5 days, but in many hospitals in Pakistan courses of 14 days remain usual practice. Longer courses increase antibiotic exposure, adverse effects and the risk of antimicrobial resistance, yet there is no randomised evidence from Pakistan on whether a shorter course is as effective for hospitalised patients.

Intervention: The experimental arm receives a 7-day systemic antibiotic course and the active comparator arm the conventional 14-day course. The treating physician chooses the agent, dose and route according to institutional practice and available microbiology, so only the planned duration differs between arms. Duration is counted from the first antibiotic dose for the current exacerbation. All other care, including bronchodilators, corticosteroids, oxygen and ventilatory support, follows usual practice in both arms. The intervention was developed through a three-round Delphi consensus process with prescribers before the trial began.

Procedures: Blood and sputum samples are taken at baseline for culture and susceptibility testing; results may guide a change of agent but do not change the allocated duration. Participants are assessed during treatment (Day 3-5), at Day 7, at Day 14 and at Day 30, in hospital or by telephone. Allocation uses a computer-generated sequence with permuted blocks of variable size, concealed through a web-based randomisation system.

Sample size: Assuming 80% clinical success in both arms, a non-inferiority margin of 10 percentage points, a one-sided alpha of 0.025 and 80% power, 252 evaluable participants per arm are required; allowing for 10% attrition, 560 participants will be enrolled.

Analysis: The primary analysis estimates the risk difference in clinical success at Day 30 (7-day minus 14-day) with a two-sided 95% Miettinen-Nurminen confidence interval. Non-inferiority will be concluded only if the lower confidence limit exceeds -10 percentage points in both the intention-to-treat and per-protocol populations. Full details are given in the study protocol (version 2.0) and statistical analysis plan (version 1.1).

Being tested
7-day antibiotic course, 14-day antibiotic course
Keywords
COPD, ACOPD, Antibiotic duration, Pakistan, ICU
Medical subject headings
Pulmonary Disease, Chronic Obstructive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • 7-day antibiotic courseDrug

    Systemic antibiotic therapy is given for a total of 7 days, counted from the first dose for the current exacerbation. The agent, dose and route are chosen by the treating physician according to institutional practice, suspected cause and available microbiology; only the planned duration differs from the comparator.

  • 14-day antibiotic courseDrug

    Systemic antibiotic therapy given for a total of 14 days, counted from the first dose for the current exacerbation, which is usual practice at the study hospital. The agent, dose and route are chosen by the treating physician according to institutional practice, suspected cause and available microbiology; only the planned duration differs from the experimental arm.

Study groups in NCT07708337
Study groupRoleWhat they receive
7-day antibiotic courseExperimentalParticipants receive systemic antibiotic therapy for a total of 7 days, counted from the first dose for the current exacerbation. The treating physician chooses the antibiotic agent, dose and route; all other care follows usual practice.
Receives: Drug: 7-day antibiotic course
14-day antibiotic courseActive comparatorParticipants receive systemic antibiotic therapy for a total of 14 days, counted from the first dose for the current exacerbation, which is the usual practice at the study hospital. The treating physician chooses the antibiotic agent, dose and route; all other care follows usual practice.
Receives: Drug: 14-day antibiotic course

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical Success at Day 30

    Number and proportion of participants with clinical success at Day 30 (±3 days) after randomisation, compared between arms as a risk difference (7-day minus 14-day) with a non-inferiority margin of -10 percentage points. Clinical success requires all of: (a) resolution or substantial improvement of the exacerbation-related signs and symptoms present at baseline (dyspnoea, sputum volume and sputum purulence), judged by the blinded outcome assessor using predefined criteria, with a reduction of at least 2 points from baseline in the COPD Assessment Test score; (b) no additional or alternative systemic antibiotic for a respiratory indication after the allocated course, and no extension of the course because of lack of improvement; (c) no hospital readmission or emergency department visit for AECOPD; and (d) the participant is alive. Participants who do not meet all four criteria are classified as clinical failures.

    Measured: Day 30 (±3 days) after randomisation

Secondary outcomes (8)
  1. Clinical Success at Day 14

    Number and proportion of participants with clinical success at Day 14 (±2 days) after randomisation, defined as for the primary outcome, compared between arms as a risk difference.

    Measured: Day 14 (±2 days) after randomisation

  2. Time to Resolution of Exacerbation Symptoms

    Number of days from randomisation to resolution of the exacerbation symptoms present at baseline.

    Measured: From randomisation up to Day 30

  3. Incidence of Antibiotic-Related Adverse Events and Serious Adverse Events

    Number of participants with at least one adverse event or serious adverse event related to antibiotic treatment.

    Measured: From randomisation up to Day 30

  4. Treatment Failure

    Number of participants with treatment failure, defined as the need for additional or alternative systemic antibiotics because of clinical deterioration or lack of improvement, escalation to non-invasive or invasive ventilation or intensive care after Day 3, or death.

    Measured: From randomisation up to Day 30

  5. Relapse

    Number of participants with a new or worsening exacerbation requiring systemic antibiotics or corticosteroids after initial clinical improvement.

    Measured: From randomisation up to Day 30

  6. Rehospitalisation for Any Cause and for AECOPD

    Number of participants readmitted to hospital, reported separately for any cause and for acute exacerbation of COPD.

    Measured: Within 30 days after randomisation

  7. All-Cause Mortality

    Number of participants who die from any cause.

    Measured: Within 30 days after randomisation

  8. Total Antibiotic Consumption

    Total systemic antibiotic consumption per participant, expressed in defined daily doses (DDD).

    Measured: From randomisation up to Day 30

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Jul 2026
  2. Study start26 Oct 2026 (estimated)
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion28 Feb 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Two-arm, parallel-group, randomised non-inferiority trial. Participants are allocated 1:1 to a 7-day or 14-day antibiotic course and followed for 30 days.
Masking
None (open label)
Enrolment
560 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07708337
Sponsor's protocol ID
IRB-113-07-08-25
Acronym
CDA
Status last verified
Oct 2026
First submitted
3 Jul 2026
Last updated
7 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual participant data underlying the published results will be made available to researchers on reasonable request to the corresponding author after publication, subject to institutional and ethical approval.

Publications

  • Chan AW, Boutron I, Hopewell S, Moher D, Schulz KF, Collins GS, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne DR, Farmer AJ, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson DJ, Vohra S, White IR, Hrobjartsson A. SPIRIT 2025 statement: updated guideline for protocols of randomised trials. Lancet. 2025 May 17;405(10491):e19-e27. doi: 10.1016/S0140-6736(25)00770-6. Epub 2025 Apr 28.

    PubMed 42290521
  • Wang Y, Zijp TR, Bahar MA, Kocks JWH, Wilffert B, Hak E. Effects of prophylactic antibiotics on patients with stable COPD: a systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2018 Dec 1;73(12):3231-3243. doi: 10.1093/jac/dky326.

    PubMed 30189002
  • Vanoverschelde A, Van Hoey C, Buyle F, Den Blauwen N, Depuydt P, Van Braeckel E, Lahousse L. In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study. BMC Pulm Med. 2023 Apr 25;23(1):138. doi: 10.1186/s12890-023-02426-3.

    PubMed 37098509

Questions about this trial

What is this clinical trial studying?

A study testing 7-day antibiotic course and 14-day antibiotic course in people with COPD and Acute Exacerbation of COPD, run by Capital Development Authority (CDA) at 1 site in Pakistan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Fazal Rabbi, MD (+923035646227, faiz@bjmu.edu.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical Success at Day 30 (time frame: Day 30 (±3 days) after randomisation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07708337, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.

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