Antibiotics for treatment and prevention ofexacerbations of chronic obstructive pulmonary disease

Robert Wilson, Sanjay Sethi, Antonio Anzueto, Marc Miravitlles

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations


Acute exacerbations (AE) can be recurrent problems for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) increasing morbidity and mortality. Evidence suggests that ≥50% of acute exacerbations involve bacteria requiring treatment with an antibiotic which should have high activity against the causative pathogens. However, sputum analysis is not a pre-requisite for antibiotic prescription in outpatients as results are delayed and patients are likely to be colonised with bacteria in the stable state. Clinicians rely on the clinical symptoms, sputum appearance and the patient's medical history to decide if an AE-COPD should be treated with antibiotics. This article reviews the available data of antibiotic trials in AE-COPD. Management of frequent exacerbators is particularly challenging for physicians. This may include antibiotic prophylaxis, especially macrolides because of anti-inflammatory properties; though successful in reducing exacerbations, concerns about resistance development remain. Inhalation of antibiotics achieves high local concentrations and minimal systemic exposure; therefore, it may represent an attractive alternative for antibiotic prophylaxis in certain COPD patients. Inhaled antibiotic prophylaxis has been successfully used in other respiratory conditions such as non-cystic fibrosis bronchiectasis which itself might be present in COPD patients who have chronic bacterial infection, particularly with Pseudomonas aeruginosa.

Original languageEnglish (US)
Pages (from-to)497-515
Number of pages19
JournalJournal of Infection
Issue number6
StatePublished - Dec 2013


  • Acute bacterial exacerbation of COPD
  • Antibiotics
  • Chronic inflammation
  • Fluoroquinolones
  • Inhalation therapy
  • Long-term outcome
  • Macrolides

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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