Antibiotic use in patients hospitalized with chronic obstructive pulmonary disease

We read with interest the report by Amin and colleagues1 outlining treatment patterns for patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The authors noted that the majority of patients included in their analysis received appropriate guideline-recommended therapy, including 91.6% of patients who received antibiotics. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report noted that AECOPD is most often triggered by viral or bacterial pathogens.2 Dimopoulos and colleagues3 evaluated the epidemiology of viral pathogens in AECOPD and found that over 50% of patients seeking treatment at a hospital for AECOPD tested positive for a virus, while a bacterial pathogen was isolated in only 14% of patients. Given the challenges associated with differentiating viral and bacterial etiologies, GOLD recommends the use of antibiotic therapy in patients with 3 cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence.2 In addition, antibiotics are also recommended in patients with increased sputum purulence and 1 other cardinal symptom and in patients requiring mechanical ventilation.