The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis.
The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components--emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more-common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less-common nonenteric, gram-negative organisms including Pseudomonas aeruginosa, gram-positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk-stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk-stratification approach for elderly patients, first-line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more-limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second-line antibiotics (e.g., amoxicillin/clavulanic acid, second- or third-generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment.
Albertson
Timothy E
TE
Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine University of California at Davis, Sacramento, California, USA. tealbertson@ucdavis.edu
Louie
Samuel
S
Chan
Andrew L
AL
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D001987:Bronchiectasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D029481:Bronchitis, Chronic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology
D000900:Anti-Bacterial Agents
Thorax. 2008 May;63(5):415-22
18234905
Annu Rev Pathol. 2009;4:435-59
18954287
Int J Chron Obstruct Pulmon Dis. 2009;4:45-53
19436696
Chest. 2003 May;123(5):1684-92
12740290
Curr Opin Pulm Med. 2008 Nov;14(6):595-9
18812838
Chest. 2000 Feb;117(2 Suppl):1S-4S
10673465
Can Fam Physician. 2009 Jan;55(1):60-7
19155372
Chest. 2003 Mar;123(3):772-7
12628877
Clin Infect Dis. 2001 May 15;32 Suppl 2:S81-93
11320449
Drugs Aging. 2002;19(10):761-75
12390053
Lancet. 2007 Sep 1;370(9589):741-50
17765523
Ageing Res Rev. 2004 Jan;3(1):55-67
15163102
Thorax. 2006 Oct;61(10):843-8
16928716
Value Health. 2001 Sep-Oct;4(5):370-5
11705127
Proc Am Thorac Soc. 2005;2(5):433-9
16322596
Clin Ther. 1999 Mar;21(3):576-91
10321424
J Int Med Res. 2001 Jul-Aug;29(4):314-28
11675905
Eur Respir J. 2005 Jun;25(6):1001-10
15929954
Pulm Pharmacol Ther. 2006;19(5):311-9
16260162
Clin Microbiol Rev. 2001 Apr;14(2):336-63
11292642
Thorax. 2002 Feb;57(2):137-41
11828043
Int J Antimicrob Agents. 2007 Jan;29(1):56-61
17189096
Int J Antimicrob Agents. 2007 Jul;30(1):52-9
17512704
Ann Intern Med. 1987 Feb;106(2):196-204
3492164
Fam Pract. 2007 Sep;24(4):317-22
17602175
Clin Ther. 2006 Aug;28(8):1175-1180
16982294
Value Health. 2008 Jul-Aug;11(4):628-36
18194402
Respir Med. 2003 Mar;97(3):242-9
12645831
Cochrane Database Syst Rev. 2002;(4):CD003900
12519615
Clin Infect Dis. 2005 Jul 1;41(1):118-21
15937772
Int J Chron Obstruct Pulmon Dis. 2008;3(4):515-20
19281070
Chest. 2009 Apr;135(4):975-982
19017866
Chest. 2008 Mar;133(3):756-66
18321904
Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1498-505
9603129
Am J Respir Crit Care Med. 2004 Aug 15;170(4):400-7
15130905
Chest. 1998 Jun;113(6):1542-8
9631791
Int J Antimicrob Agents. 2004 Feb;23(2):129-37
15013037
Chest. 2000 May;117(5 Suppl 2):398S-401S
10843984
Can Respir J. 2008 Jan-Feb;15 Suppl A:1A-8A
18292855
N Engl J Med. 2002 Aug 15;347(7):465-71
12181400
Eur Respir J. 2007 Jun;29(6):1127-37
17301097
Drugs Aging. 2007;24(7):555-72
17658907
Swiss Med Wkly. 2003 May 3;133(17-18):247-57
12833195
Curr Opin Infect Dis. 2006 Jun;19(3):225-30
16645482
Drugs Aging. 2004;21(13):851-64
15493950
Lancet Infect Dis. 2006 Oct;6(10):629-40
17008172
Proc Am Thorac Soc. 2007 Oct 1;4(7):554-64
17878469
Am J Manag Care. 2004 Oct;10(10):689-96
15521160
Chest. 2008 Oct;134(4):815-823
18842914
Clin Infect Dis. 2005 Aug 15;41 Suppl 4:S234-8
16032558
Respir Med. 2007 Jun;101(6):1097-105
17239575
J Antimicrob Chemother. 2008 Sep;62(3):442-50
18467303
Chest. 2004 Mar;125(3):953-64
15006954
Ther Adv Respir Dis. 2007 Oct;1(1):61-76
19124348
Drugs Aging. 2009;26(6):447-56
19591519
Chest. 2000 May;117(5 Suppl 2):380S-5S
10843981
JAMA. 2003 Nov 5;290(17):2301-12
14600189
Can Respir J. 2000 Nov-Dec;7(6):466-71
11121091
Respir Med. 2006 Sep;100(9):1504-11
16504492
J Chemother. 2002 Dec;14(6):597-608
12583552
Clin Ther. 2001 Jan;23(1):72-86
11219481
Pulm Pharmacol Ther. 2006;19(5):361-9
16289762
Chest. 2007 Aug;132(2):447-55
17573508
Can Respir J. 2003 Jul-Aug;10 Suppl B:3B-32B
12944998
Int J Chron Obstruct Pulmon Dis. 2008;3(3):331-50
18990961
Eur Respir J. 2006 Feb;27(2):397-412
16452599
Chest. 2009 Jan;135(1):173-180
19136405
JAMA. 1995 Mar 22-29;273(12):957-60
7884956
South Med J. 2009 Mar;102(3):277-82
19204646
Respir Med. 2004 Feb;98(2):99-107
14971871
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004403
16625602