Prudent use of antibiotics: acute exacerbation of COPD as an example

Abstract

This is an important year for respiratory medicine, as 2010 has been declared “Year of the Lung”. A multitude of activities have been prepared long in advance and many important initiatives are on their way or yet to come. The European Centre for Disease Prevention and Control (ECDC) has, in parallel, been campaigning for several years for a more prudent use of antibiotics 1. Last year was devoted to promoting prudent use of antibiotics to primary care prescribers and this year, a campaign promoting prudent antibiotic use to hospital prescribers is well under way 2. The majority of antibiotics are prescribed for respiratory infections and tuberculosis. The secretary of European Respiratory Society (ERS) Assembly 10 (Respiratory Infections and Tuberculosis) and members of ECDC met recently in order to organise support for European Antibiotic Awareness Day, planned for November 18, 2010. On this date, international respiratory societies also celebrate World COPD Day. This coincidence may be regarded as a signal to illustrate important common aspects of chronic obstructive pulmonary disease (COPD) management and antibiotic awareness. Antibiotic-resistant strains of pathogenic bacteria are increasingly prevalent in hospitals and the community. Antibiotic prescriptions without clear indication contribute significantly to the increase in antibiotic resistance 3. Acute exacerbation of COPD (AE-COPD), a disease which has become a leading cause of morbidity and mortality worldwide, often results in administration of antibiotics. For example, in one study, antibiotics were found to have been prescribed in 85% of 69,820 patients admitted for AE-COPD to 360 hospitals throughout the USA 4. The evidence for antibiotic prescription for AE-COPD is weak. Recent data suggest that ∼70% of exacerbations are infectious in origin 5. Of these, only 20–30% can be related to bacteria detected by sputum culture 5. It is difficult to prove that pathogens …