Medical Minute: Should All Patients with COPD Exacerbations Be Treated with Antibiotics?

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September 10, 2014 by dailybolusoflr

By: Wing Province, MD
 Miravitlles M et al. Chest 2013 Nov.

In those with mild-to-moderate chronic obstructive pulmonary disease, only purulent sputum and high C-reactive protein levels predicted need for antibiotics.
Summary:
Data:
– 80% (n = 122) did well w/o Abx.
– 20% (n = 30) did NOT do well w/o Abx –> Who? How can I predict?
First, define a COPD exacerbation (3 Factors):
1. Dyspnea
2. Increased volume of sputum
3. Increased purulence of sputum (color change)
Question: Which sx was most predictive of needing Abx? (purulence)
Question: Which lab test is most predictive of needing Abx? (CRP >4.0)

ConclusionThe two best predictors of potential benefit from antibiotics were purulent sputum and C-reactive protein (CRP) level >4.0 mg/L.

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