Question 23

What are the implications of this data for treatment practice?

This is a multinational study covering a wide Asia-Pacific region and provides information for physicians throughout the area. It allows doctors in specific areas to know what the most likely pathogens will be and makes them aware that the classic bacteriology of AECOPD may not be true in their region. Therefore, they would need to cover enteric Gram-negatives, such as K. pneumoniae, and non-enteric Gram-negatives, such as P. aeruginosa and A. baumannii, rather than the more usual S. pneumoniae, H. influenzae and M. catarrhalis. Secondly, these results encourage researchers and clinicians to evaluate local antibiograms and gain a clearer understanding of local resistance patterns.
One of the most important parts of this study is data outlining antibacterial activity of specific antibiotics. Results confirmed that levofloxacin had the greatest coverage on a percentage basis, approximately 93% of all isolates being susceptible, which is comparable to the most powerful injectable agent. Using in vitro susceptibility, it was shown that all other agents tested provided less coverage. However, this does not automatically mean that a fluoroquinolone should be used in all patients with suspected AECOPD although it does mean those who present with moderate or severe disease, or those requiring hospitalization, are likely to require treatment of more difficult pathogens. Therefore, for these patients, levofloxacin would be an appropriate choice because it achieves good therapeutic levels and covers all of the likely pathogens.