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

Clinical failure after initial treatment for exacerbations of chronic obstructive pulmonary disease (COPD) occurs in 10-25% of cases. Once the original diagnosis is confirmed, there is a need to optimise therapy, including introducing bronchodilators and corticosteroids. The use of aggressive antibiotic 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 with bronchiectasis. Consideration of less common pathogens, such as Pseudomonas aeruginosa infection, should also be considered. Bacteria usually associated with exacerbations are becoming increasingly resistant, and this needs to be considered when deciding on appropriate antibiotic treatment.