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Criteria for Patient with COPD Exacerbation Who Does Not Require Antibiotic Therapy

Purpose: To identify a patient with a COPD exacerbation who does not require antibiotic therapy based on the study of van der Valk et al.

Description

Van der Valk et al evaluated antibiotic therapy for patients with an exacerbation of chronic obstructive pulmonary disease (COPD). They identified a group of patients who do not benefit from antibiotic therapy. The authors are from Medisch Spectrum Twente, regional Laboratory of Public Health, and University medical Centre Nijmegen in The Netherlands.


 

Patient selection: exacerbation of COPD

 

A bacterial infection was associated with the exacerbation in 19% of cases.

 

A patient does not require antibiotic therapy if all of the following are present:

(1) sputum Gram stain negative

(2) absence of a clinically relevant decrease in lung function

(3) 0 or 1 COPD exacerbation in the past year

 

A patient with all of the following had a 67% chance of having a bacterial infection:

(1) sputum Gram stain positive

(2) a clinically relevant decrease in lung function

(3) 2 or more COPD exacerbations in the past year

 

where:

• Change in FEV1 was used to define lung function. A clinically relevant decrease was > 12% and > 200 mL from baseline.

• A positive sputum Gram stain was based on identification of pathogenic or potentially pathogenic bacteria. White blood cells were not considered.

 


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Specialty

Objective

ICD-10