Question 26

What other factors need to be considered when choosing antibacterial treatment of ABECOPD in Asia?

This is a difficult issue because a number of factors need to be considered in the decision-making process. For example, the cost of the actual antibiotic may have a greater impact in Asia than in the USA. Some fluoroquinolones are relatively costly in Asia compared with other older agents including TMP-SMX, co-trimoxazole or penicillins. However, this needs to be weighed against the possibility of treatment failure, need for hospitalization and requirement for retreatment.
Another issue when deciding upon the optimal treatment regimen is improving compliance. It is important to balance eradication of the pathogen with the probability of developing resistant organisms. Therefore, if a short-course regimen is used, it is imperative that a dose is prescribed that will achieve the goals of therapy. It is not appropriate to give a short-course regimen using an ineffective dose. While clinical symptoms may improve, ultimately, if the pathogen is not eradicated, patients will either relapse or start to develop resistant bacterial flora. This is why the high-dose, short-course levofloxacin regimen is so advantageous. I believe that in Asia, physicians and patients are becoming used to treatment with higher-dose, once-daily therapy and authorities are starting to think in terms of a minimum course of therapy.