Antibiotic Therapy in Preventing Exacerbations of Severe Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life. The above are attainable by lifestyle changes and pharmacotherapy. The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD. The search included PubMed, Cochrane and Clinical Key databases. Keywords searched include: chronic obstructive pulmonary disease, antibiotics, macrolides, antibacterial, azithromycin, bronchodilators, standard therapy, COPD exacerbations, adverse effects, and long-term. The gold standard for pharmacotherapy consists of bronchodilators (long-acting beta2 agonist (LABA)). Patients with moderate to severe COPD displayed improved quality of life and decreased exacerbations requiring hospitalization (18 fewer per 1000) while using a LABA compared to placebo. As the disease progresses, bronchodilators are not as effective and additional therapy is required which may include long-term antimicrobial therapy. Adding azithromycin to standard therapy for patients with frequent exacerbations showed a 27% reduction in exacerbation frequency. With prolonged use of antimicrobials there is an increased risk of bacterial resistance. However, in doing this research, it was found that bacterial resistance was not noticed between azithromycin (52%) versus placebo (57%), p = 0.64. Although long-term antimicrobial therapy is becoming a hot topic, it is imperative that we continue to study the detrimental development of bacterial resistance