Hillberg R E
Am J Manag Care. 2000 May;6(8 Suppl):S427-36.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and the second leading cause of work disability. Extensive data indicate that bacterial infection has an important role in acute exacerbations of COPD. Antibiotic therapy has been shown to benefit patients with exacerbations of COPD by improving clinical outcomes and hastening clinical and physiologic recovery. Antibiotics also provide long-term benefits such as preventing the progression of disease, minimizing secondary colonization with resistant organisms, and prolonging the time between exacerbations. Classifying an episode of COPD as uncomplicated, complicated, or at risk for Pseudomonas is useful in determining antibiotic therapy for patients with an acute exacerbation. Although patients with less severe uncomplicated disease can be treated with older antimicrobial agents, those with serious comorbid conditions or advanced structural lung disease require treatment with new more potent agents. Knowing the patterns of antimicrobial resistance in the respiratory pathogens, antibiotic pharmacokinetics, and factors influencing patient compliance is necessary to prevent treatment failures.
慢性阻塞性肺疾病（COPD）是美国第四大死因及第二大致残原因。大量数据表明，细菌感染在COPD急性加重中起重要作用。抗生素治疗已显示可通过改善临床结局及加速临床和生理恢复，使COPD加重患者获益。抗生素还具有长期益处，如预防疾病进展、减少耐药菌的继发定植及延长加重发作间隔时间。将COPD发作分类为单纯性、复杂性或有假单胞菌感染风险，有助于确定急性加重患者的抗生素治疗方案。虽然病情较轻的单纯性疾病患者可用较老的抗菌药物治疗，但有严重合并症或晚期结构性肺病的患者则需要用更新、更有效的药物治疗。了解呼吸道病原体的耐药模式、抗生素药代动力学及影响患者依从性的因素，对于预防治疗失败很有必要。
