title: Severe acute exacerbations of chronic obstructive pulmonary disease: does the dosage of corticosteroids and type of antibiotic matter?
abstract: OBJECTIVE
  Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are significant events that result in substantial morbidity and mortality. Antibiotic therapy and systemic corticosteroids are important treatments for patients with severe AECOPD. The objective of this review is to summarize the most recent evidence concerning antibiotic and corticosteroid therapy, with a focused evaluation on the contribution of antibiotic type and corticosteroid dosage on patient outcomes.
  
  
  RESULTS
  Macrolides should be considered the antibiotic of choice for prevention of AECOPD in patients who qualify for therapy. Macrolides, fluoroquinolones, and beta-lactams are all reasonable treatment options for severe AECOPD and the decision to use one over the other should be based upon patient characteristics and institutional or regional antimicrobial susceptibility patterns. The best available evidence now suggests that higher-dose corticosteroids are not superior to treatment with lower-dose corticosteroids in patients with severe AECOPD. Additionally, longer durations of systemic corticosteroid therapy do not improve clinical outcomes.
  
  
  CONCLUSIONS
  Several antibiotic options are efficacious in the management of severe AECOPD and drug selection should be patient-specific. Recent studies suggest that lower dosages and shorter durations of corticosteroid treatment may be prudent.
authors.affiliation: aDepartment of Clinical Pharmacy bDepartment of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, COPD Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Tyree H
authors.initials: TH
authors.lastname: Kiser
authors.forename: R William
authors.initials: RW
authors.lastname: Vandivier
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids