Which Antibiotic for Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Although exacerbations of chronic obstructive pulmonary disease (COPD) often do not require antibiotic therapy, when a COPD patient is sick enough for intensive care unit (ICU) admission and intubation, an antibiotic is always indicated. But which one?

In a blinded double-dummy study, Tunisian researchers randomized 170 adults with acute exacerbations of COPD and respiratory failure to receive either oral ciprofloxacin or oral trimethoprim-sulfamethoxazole (TMP-SMX) for 10 days, in addition to standard ICU care. Most patients were men, and all were heavy smokers; none was febrile or had radiologic evidence of pneumonia. Mortality during hospitalization was similar in both groups (<10%), as was perceived antibiotic failure that required a dif…