title: Antibiotics for treatment and prevention of exacerbations of chronic obstructive pulmonary disease.
abstract: Acute exacerbations (AE) can be recurrent problems for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) increasing morbidity and mortality. Evidence suggests that ≥50% of acute exacerbations involve bacteria requiring treatment with an antibiotic which should have high activity against the causative pathogens. However, sputum analysis is not a pre-requisite for antibiotic prescription in outpatients as results are delayed and patients are likely to be colonised with bacteria in the stable state. Clinicians rely on the clinical symptoms, sputum appearance and the patient's medical history to decide if an AE-COPD should be treated with antibiotics. This article reviews the available data of antibiotic trials in AE-COPD. Management of frequent exacerbators is particularly challenging for physicians. This may include antibiotic prophylaxis, especially macrolides because of anti-inflammatory properties; though successful in reducing exacerbations, concerns about resistance development remain. Inhalation of antibiotics achieves high local concentrations and minimal systemic exposure; therefore, it may represent an attractive alternative for antibiotic prophylaxis in certain COPD patients. Inhaled antibiotic prophylaxis has been successfully used in other respiratory conditions such as non-cystic fibrosis bronchiectasis which itself might be present in COPD patients who have chronic bacterial infection, particularly with Pseudomonas aeruginosa.
authors: Host Defence Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Electronic address: r.wilson@rbht.nhs.uk.
authors: Robert
authors: R
authors: Wilson
authors: Sanjay
authors: S
authors: Sethi
authors: Antonio
authors: A
authors: Anzueto
authors: Marc
authors: M
authors: Miravitlles
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute bacterial exacerbation of COPD; Antibiotics; Chronic inflammation; Fluoroquinolones; Inhalation therapy; Long-term outcome; Macrolides