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Semin Respir Crit Care Med 2000; 21(2): 0113-0122
DOI: 10.1055/s-2000-9932
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Use of Guidelines and Risk Stratification in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Ronald F. Grossman
  • University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Publication History

Publication Date:
03 March 2004 (online)

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ABSTRACT

Guidelines have been developed to simplify the antimicrobial treatment decision for patients with acute exacerbations of chronic obstructive lung disease. Approximately half of these patients will have a demonstrable bacterial infection and antibiotics have been demonstrated to shorten the clinical illness and prevent significant deterioration. Patients can be stratified by the risk of treatment failure with usual first-line antimicrobial agents. Patients presenting with worsening dyspnea, increased sputum volume and purulence should be offered antimicrobial therapy. In the presence of significant impairment of lung function (FEVI 50% predicted), frequent exacerbations, significant comorbidity, malnutrition, chronic corticosteroid administration and long duration of disease, should be treated with more aggressive therapy such as with a fluoroquinolone, amoxicillin-clavulanate, or a second or third generation cephalosporin or second generation macrolide. In the absence of these risk factors, first-line agents such as amoxicillin appear adequate. Patients with chronic suppurative airway disease (mainly bronchiectasis) should be treated with an antipseudomonal fluoroquinolone if P. aeruginosa is identified in pulmonary secretions. More prospective randomized trial are warranted to validate this approach.

@ab:Key Words: Chronic obstructive lung disease, antibiotics, guidelines, acute exacerbation of chronic obstructive lung disease

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