title: Management of clinical failures in non-ICU patients with chronic obstructive pulmonary disease exacerbations.
abstract: Clinical failure after initial treatment for exacerbations of chronic obstructive pulmonary disease (COPD) occurs in 10-25% of cases. Once the original diagnosis is confirmed, there is a need to optimise therapy, including introducing bronchodilators and corticosteroids. The use of aggressive antibiotic treatment is recommended for patients with risk factors (elderly, more than four exacerbations per year, underlying cardiopulmonary disease) and more severe disease. Fluoroquinolones are a good choice for those patients who failed initial therapy and who require antimicrobials, including those with simple exacerbations, complicated cases with comorbidity, or those with bronchiectasis. Consideration of less common pathogens, such as Pseudomonas aeruginosa infection, should also be considered. Bacteria usually associated with exacerbations are becoming increasingly resistant, and this needs to be considered when deciding on appropriate antibiotic treatment.
authors.affiliation: Pulmonary Section, Veterans Affairs Medical Center, and the Respiratory Sciences Center, University of Arizona, Tucson, Ariz. 85723, USA. mhabib@resp-sci.arizona.edu
authors.forename: M P
authors.initials: MP
authors.lastname: Habib
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000209:etiology; D006801:Humans; D008297:Male; D015242:Ofloxacin / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D015242:Ofloxacin