UMEM Educational Pearls

Category: Critical Care

Title: Antibiotics for Acute Exacerbations of COPD

Keywords: COPD, respiratory failure, antibiotics, ICU (PubMed Search)

Posted: 11/24/2015 by Daniel Haase, MD
Click here to contact Daniel Haase, MD

--The role of antibiotics in acute exacerbations of COPD remains controversial in many settings. However, a recent Cochrane review concludes that antibiotics have "large and consistent" benefit in ICU admissions [1]:

  • decreased length of hospital stay
  • decreased treatment failure
  • decreased mortality

--However, patients on antibiotics had increased side effects, are at risk for increased drug-drug interaction (think azithromycin/levofloxacin), and the effect on multi-drug resistance is unclear.

--GOLD Guidelines are a bit more liberal with their recommendations for antibiotics [2], recommending antibiotics based on symptoms or in patients needing mechanical support.

--TAKEAWAY -- if your patient needs BiPAP or ICU, they should also get antibiotics!


1. Vollenweider DJ, Jarrett H, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012 Dec 12;12:CD010257. doi: 10.1002/14651858.CD010257. Review. PubMed PMID: 23235687