Pharmacotherapeutic management of bronchial infections in adults: non-cystic fibrosis bronchiectasis and chronic obstructive pulmonary disease

ABSTRACT

Introduction

Effective management of both acute and chronic bronchial infections is mandatory due to their high frequency rate, the relevant morbidity and mortality and the significant burden to health care systems, especially with the aging of population. Bacteria are the main causative pathogens, followed by viruses, and less commonly by fungi.

The clinical evaluation of new therapeutic associations is mandatory to cope with the increases in resistance, in association with better infection control and antimicrobial policies.

Areas covered

The authors searched Medline for any article published in English language up until March 1, 2020 that concerns the treatment of acute exacerbations and chronic infections in chronic obstructive respiratory disease and bronchiectasis.

Expert opinion

As acute exacerbations are a main common and detrimental event in patients with COPD and bronchiectasis, effective antimicrobial therapies and regimens should be optimized. The development of new molecules or combination regimens is vital to patients with severe and/or difficult-to-treat infections. Moreover, chronic infection control is mandatory in these patients to their improve quality of life, respiratory function and prognosis as well as for reducing health care costs.

KEYWORDS:

• Exacerbation
• chronic obstructive pulmonary disease
• bronchiectasis
• antibiotics
• chronic infection

Article highlights

• Effective management of acute and chronic bronchial infections is mandatory due high frequency rate, relevant morbidity and mortality and significant burden to health care systems.

• A short duration of treatment and de-escalation therapy should be preferred to reduce the development of resistance.

• In bronchiectasis patients, inhaled antibiotics could be used in patients with chronic infections by P. aeruginosa to control bacterial load, decrease the rate of acute exacerbations and preserve lung functions.

• Long-term oral antibiotic treatments in COPD are still debated, concerning potential benefits in comparison to side effects.

• Development of new molecules or new combinations regimens are very important for patients with severe and/or difficult-to-treat infections.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This manuscript has not been funded.