Antibiotic therapy and prophylaxis in COPD

Bacteria are held responsible for a significant proportion of chronic obstructive pulmonary disease (COPD) exacerbations although demonstration of appreciable beneficial effects following antibiotic treatment has been difficult to obtain. Recent evidence suggests that antimicrobial treatment is not indicated in all COPD patients with exacerbations and that adequate patient stratification is essential. Among the factors associated with greatest benefit following antibiotic therapy are sputum purulence, patient severity, and presence of comorbidities. It is now recognized that exacerbation microbiology varies with baseline disease severity, with Gram-negative bacteria and Pseudomonas aeruginosa more commonly encountered in more severely compromised patients. Antibiotic selection must take into consideration patient characteristics and probable etiologic agents. A significant number of COPD patients have persistent airway bacterial colonization outside exacerbation episodes. Recently, prophylactic antibiotic use in these patients has recently received renewed attention.