Management of clinical failures in non-ICU patients with chronic obstructive pulmonary disease exacerbations

Clinical failure after initial treatment for exacerbations of chronic obstr uctive pulmonary disease (COPD) occurs in 10-25% of cases. Once the origina l diagnosis is confirmed, there is a need to optimise therapy, including in troducing bronchodilators and corticosteroids. The use of aggressive antibi otic treatment is recommended for patients with risk factors (elderly, more than four exacerbations per year, underlying cardiopulmonary disease) and more severe disease. Fluoroquinolones are a good choice for those patients who failed initial therapy and who require antimicrobials, including those with simple exacerbations, complicated cases with comorbidity, or those wit h bronchiectasis. Consideration of less common patho-gens, such as Pseudomo nas aeruginosa infection, should also be considered. Bacteria usually assoc iated with exacerbations are becoming increasingly resistant, and this need s to be considered when deciding on appropriate antibiotic treatment. Copyr ight (C) 2001 S. Karger AG, Basel.