CC Nov 2014 Abx prophylaxis for COPD exacerabations

echoecho's version from 2015-06-30 18:55


Question Answer
List characteristics of GOLD group D?frequent exacerbations, significantly reduced FEV1, marked symptoms
Is there evidence that prophylactic abxs may help to reduce COPD exacerbations?yes
*** What was the results of a 2013 Cochrane review ath looked at 7 randomized controlled trials of 3170 patients with frequent exacerbations requiring rx w/ abxs or steroids or who were on oxygen. Five studies involved continous antibiotics and 2 studies used pulsed (intermittent) abxs. Macrolides were employed?1) continous antibiotics decreased the number of pts experiencing an exacerbation (69% in control vs 54% in treated group) 2. with a number needed to treat (NNT) of 8. 3) frequence of exacerbations was also decreased 4) pulsed therapy showed only a nonsignificant decrease in the number of pts with exacerbations 5) neither continuous nor pulsed therapy affected the frequenc of hospital admissions, lung function, serious adverse events or all-cause mortality 6)quality of life improved with both methods of antibiotic administration
Another study found significantly reduced risk of exacerbation and longer interval to exacerbation with daily _______ therapy? Increased risk of what with this therapy?azithromycin; hearing loss
List 3 concerns with prophylactic antibiotic therapy?1) development of resistance 2) macrolides inhibit ZCYP 3A4 of the cytochrome P-450 enzyme system (particularly erythromycin and clarithromycin) thus resulting in potential adverse reactions with drugs that are metabolized via this system 3) macrolides are associated with QTc prolongation
Assessment of patient for antibiotic prophylatic therapy with what conditions are less favorable candidates?1) identify those patients with preexisting QTc prolongation 2) or who are on other meds that can cause QTc prolongation 3) hearing loss 4) on meds metabolized by CYP 3A4
What is needed if antibiotic prophylaxis for a patient with the above is started?informed consent and joint decision making
Is Augmentin used for COPD exacerbations or prophylaxis?no