ABSTRACT
Antibiotics are frequently prescribed in patients with chronic obstructive pulmonary disease (COPD), mostly because of acute exacerbations. Nevertheless, the precise role of infection has not been determined. This is true for acute exacerbations as well as for tracheobronchial colonization in stable patients. Recent experimental as well as clinical data suggest that chronic and recurrent infections may contribute to lung function decline, and, therefore, traditional concepts of chemoprophylaxis may gain renewed attention. On the other hand, there is evidence that only subgroups of patients with COPD and acute exacerbations have benefit from antimicrobial treatment, and that antimicrobial treatment regimen must be stratified according to the severity of acute exacerbations as well as distinct risk factors for treatment failures with conventional antibiotics. Newer macrolides and quinolones represent a substantial improvement in antimicrobial treatment options. Particularly new quinolones exert formidable pharmacokinetic properties, which render these agents a good alternative for all complicated acute exacerbations. In the following, we will review the current knowledge of the role of infection and provide recommendations for a rational approach to antimicrobial treatment in COPD patients.
