Medicus, Vol. 14 No. 1_ARI, 2005.
Pregledni rad
Antibiotics in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Neven Tudorić
Sažetak
The quality of life, work productivity and
mortality rate in patients with chronic obstructive pulmonary
disease (COPD) depend on the severity and incidence
of its acute exacerbations (AE). On an average, a COPD
patient has 2-4 acute exacerbations annually and they are
most often caused by respiratory infections, smoking or
aggravation of associated clinical conditions. The success
of COPD management largely depends on the management
of AE. The antibiotics administered for AE-COPD attenuate
the symptoms of the disease, postpone new episodes and
slow down the progress of the disease. Based on the latest
knowledge, the administration of antibiotics is recommended
in moderate and severe acute exacerbations characterized
by increased sputum volume and purulence, and in patients
with severe COPD. The antibiotic therapy of AE-COPD is
most frequently empirical and based on the knowledge of
most frequent pathogens (H. infl uenzae, M. catarrhalis and
S. pneumoniae, P. aeruginosa) as well as of the resistance
of these pathogens to standard antibiotics. In outpatient
treatment of AE-COPD, doxycycline, aminopenicillins,
macrolides (azithromycin and clarithromycin), 2nd generation
cephalosporins and quinolones may be used. Doxycycline
and amoxicillin are recommended only in mild AE, while
macrolides, cephalosporines amoxicillin/clavulanic acid
and fl uoroquinolones are preferred in severe AE. In the case
of infection with P. aeruginosa, standard antipseudomonal
treatment is essential. Contemporary clinical trials have
shown that antibiotics are not equipotent in the treatment
of AE-COPD. The rational choice of antibiotics in the hospital
treatment of most severe AE-COPD cases is additionally
based on the results of various diagnostic procedures, and
the treatment usually starts with parenteral administration.
Ključne riječi
acute exacerbation of chronic obstructive pulmonary disease; treatment; antibiotics
Hrčak ID:
18831
URI
Datum izdavanja:
26.1.2005.
Posjeta: 4.771 *