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Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed?

¹ Pulmonary Section and ² Experimental Medicine Unit, Christian de Duve Institute of Cellular Pathology, University of Louvain, Belgium. ³ Pulmonary and Critical Care Medicine, Winthrop-University Hospital and State University of New York at Stony Brook, NY, USA

CORRESPONDENCE: Y. Sibille, Service de Pneumologie, Cliniques Universitaires de Mont-Godinne, Université catholique de Louvain, B-5530, Yvoir, Belgium. Fax: 32 81423352. E-mail: sibille@mexp.ucl.ac.be

Keywords: antibiotics, chronic obstructive pulmonary disease, respiratory infection, viruses

Received: November 5, 2001
Accepted November 6, 2001

Abstract

The use of antibiotics in acute exacerbations of chronic bronchitis (AECBs) remains the subject of controversy despite considerable medical and socioeconomic implications.

First, the contribution of bacterial infection to AECBs is difficult to assess in patients with chronic obstructive pulmonary disease (COPD) who are chronically colonized with respiratory pathogens. In addition, several studies suggest a major role of viral infections in AECBs.

Secondly, it is unlikely that all COPD patients will benefit from antibiotics during AECBs. In particular, the benefit in mild COPD remains uncertain. Unfortunately, the number of studies complying with evidence-based medicine requirements is too small for definite recommendations in AECBs to be drawn up.

Considering the impact of acute exacerbations of chronic bronchitis on chronic obstructive pulmonary disease patients, as well as the community, and the impact of antibiotic therapy on the development of bacterial resistance, there is an urgent need for the design of appropriate multicentric studies to define the usefulness of this type of treatment in acute exacerbations of chronic bronchitis.

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