Drugs & Aging

, Volume 19, Issue 10, pp 761–775

Chronic Obstructive Pulmonary Disease

Role of Bacteria and Guide to Antibacterial Selection in the Older Patient
Therapy in Practice

Abstract

Chronic obstructive pulmonary disease (COPD) is a common problem in the elderly. The disease is characterised by intermittent worsening of symptoms and these episodes are called acute exacerbations. The best estimate, based on several lines of evidence, is that approximately half of all exacerbations are caused by bacteria. These lines of evidence include studies of lower respiratory tract bacteriology during exacerbations, correlation of airways’ inflammation with results of sputum cultures during exacerbations, analysis of immune responses to bacterial pathogens, and the observation in randomised, prospective, placebo-controlled trials that antibacterial therapy is of benefit. The most important bacterial causes of exacerbations of COPD are nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Chlamydia pneumoniae.

In approaching the elderly patient with an exacerbation, it is useful to consider the severity of the exacerbation based on three cardinal symptoms: increased sputum volume, increased sputum purulence and increased dyspnoea compared with baseline. Patients experiencing moderate (two symptoms) or severe (all three symptoms) exacerbations benefit from antibacterial therapy.

Consideration of underlying host factors allows for a rational choice of antibacterial agent. Patients are considered to have ‘simple COPD’ or ‘complicated COPD’ based on: (i) the severity of underlying lung disease; (ii) the frequency of exacerbations; and (iii) the presence of comorbid conditions. It is proposed that patients with simple COPD are treated with doxycycline, a newer macrolide, or an extended-spectrum oral cephalosporin; and patients with complicated COPD are treated with amoxicillin/clavulanate or a fluoroquinolone. The major goals of antibacterial therapy for exacerbations of COPD are acceleration of symptom resolution and prevention of the complications of exacerbation.

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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Division of Infectious Diseases, University at BuffaloState University of New YorkBuffaloUSA
  2. 2.Department of Microbiology, University at BuffaloState University of New YorkBuffaloUSA
  3. 3.Department of Veteran Affairs Western New York Health SystemBuffaloUSA
  4. 4.Division of Pulmonary and Critical Care Medicine of the Department of Medicine, University at BuffaloState University of New YorkBuffaloUSA
  5. 5.Medical Research 151Buffalo VAMCBuffaloUSA

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