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Discriminate use of antibiotics for exacerbation of COPD

Stolz, Daiana; Tamm, Michael

Current Opinion in Pulmonary Medicine: March 2009 - Volume 15 - Issue 2 - p 126–132
doi: 10.1097/MCP.0b013e328324e6d7
Obstructive, occupational and environmental diseases: Edited by Basil Varkey

Purpose of review The relevance of antibiotics in the treatment of acute exacerbation has been a matter of debate for several years. Although expert recommendations may vary, there is general agreement about the fact that not all patients will equally experience benefit from antibiotics: apart from decreasing costs, discriminate use of antibiotics is capable of significantly reducing subsequent colonization or infection with antibiotic-resistant bacteria.

Recent findings Several meta-analyses support the concept that patients with increased dyspnea, increased sputum volume, and increased sputum purulence will benefit from antimicrobial therapy. Evidence from randomized trials substantiates the prescription of antibiotics in patients receiving mechanical ventilation and the avoidance of antibiotics in those admitted with low serum procalcitonin levels.

Summary Most of the proposed criteria for prescribing or withholding antibiotics for acute exacerbation have been analyzed in different retrospective study designs. Patients requiring ICU care and mechanical ventilation for chronic obstructive pulmonary disease exacerbation should receive antibiotics. Conversely, antibiotics can be withheld in patients admitted to the emergency department with low serum procalcitonin levels. Patients with type I Anthonisen exacerbation and those with severe functional impairment are likely to benefit from antibiotics. Further investigations are needed to compare long-term outcome in patients treated according to clinical and functional criteria.

Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland

Correspondence to PD Dr Daiana Stolz, MD MPH, Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, Basel CH-4031, Switzerland Tel: +41 61 328 7193; fax: +41 61 265 4587; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.