Treatment for Chronic Obstructive Lung Disease

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Other Medications

Statins. The same drugs used to lower cholesterol may also help protect the lungs of COPD patients, in part due to their anti-inflammatory effects. However, more research is needed to prove these benefits, and to determine the optimal statin dose for COPD patients.

Antibiotics

Treating Acute Bronchitis or Pneumonia in COPD Patients. People with COPD are at increased risk for pneumonia, but any lung infection can worsen symptoms and speed deterioration of lung function. Patients with acute bronchitis or pneumonia who have signs of bacterial infection, such as green or yellow phlegm, usually need antibiotics.

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Streptococcus pneumoniae, Haemophilus influenzae, and Moxarella catarrhalis are the most common causes of pneumonia or exacerbations in people with COPD. The choice of antibiotic depends on the bacteria being treated and bacterial resistance to common antibiotics in the area. Giving preventive antibiotics to patients with frequent exacerbations is not recommended because this practice contributes to the development of bacterial resistance.

Antibiotic Options

Beta-Lactams

Beta-lactam antibiotics include penicillins, cephalosporins, and some newer medications. They share common chemical features, and all interfere with bacterial cell walls.

Penicillins. Penicillin was the first antibiotic. Many forms of this still-important drug are available today:

• Penicillin derivatives called aminopenicillins, particularly amoxicillin (Amoxil, Polymox, Trimox, Wymox, or any generic formulation), are now the most common penicillins used. Amoxicillin is inexpensive, and at one time was highly effective against S. pneumoniae. Unfortunately, bacterial resistance to amoxicillin has increased significantly, both among S. pneumoniae and H. influenzae. Ampicillin is similar, but it requires more doses and has more severe gastrointestinal side effects than amoxicillin.
• Amoxicillin-clavulanate (Augmentin) is known as an augmented penicillin that works against a wide spectrum of bacteria and is used for more severe exacerbations. An extended-release form is also available.

Many people have a history of allergic reaction to penicillin, but some evidence suggests the allergy may not return in a significant number of adults. Skin tests are available to help determine whether someone with a history of penicillin allergies could tolerate these important antibiotics.

Cephalosporins. Most of these antibiotics are not very effective against bacteria that have developed resistance to penicillin, and are used for more severe exacerbations. They are classified according to their generation:

• Second generation: cefaclor (Ceclor), cefuroxime (Ceftin), cefprozil (Cefzil), and loracarbef (Lorabid)
• Third generation: cefpodoxime (Vantin), cefdinir (Omnicef), cefditoren (Spectracef), cefixime (Suprax), and ceftibuten (Cedex). Ceftriaxone (Rocephin) is an injected cephalosporin. These antibiotics are effective against a wide range of Gram-negative bacteria, and some are also able to treat S. pneumoniae infections.

Fluoroquinolones (Quinolones)

Fluoroquinolones ("quinolones") interfere with the bacteria's genetic material to prevent them from reproducing. These antibiotics are used for more severe exacerbations.

• "Respiratory quinolones" are currently the most effective drugs available against a wide range of bacteria. These drugs include levofloxacin (Levaquin), sparfloxacin (Zagam), and gemifloxacin (Factive). Levofloxacin was the first drug approved specifically for penicillin-resistant S. pneumoniae. Some of the newer fluoroquinolones need to be taken only once a day.
• The fourth-generation quinolones moxifloxacin (Avelox) and clinafloxacin (which is still in development) are proving effective against anaerobic bacteria.

S. pneumoniae strains that are resistant to the respiratory quinolones are uncommon in the U.S., but resistance is increasing.

Many quinolones cause side effects, including sensitivity to light and nervous system (neurologic), psychiatric, and heart problems. Pregnant women should not take this class of drugs. Quinolones also enhance the potency of oral anti-clotting drugs.

When it comes to treating acute exacerbations of chronic bronchitis, so-called second-line antibiotics (amoxicillin, clavulanate, macrolides, second- or third-generation cephalosporines, and quinolones) appear to be more effective than -- and just as safe as -- first-generation antibiotics (ampicillin, doxycycline, and trimethoprim/sulfamethoxazole).

Macrolides and Azalides

Macrolides and azalides also affect the genetics of bacteria. These drugs include:

• Azithromycin (Zithromax, Zmax)
• Clarithromycin (Biaxin)
• Erythromycin
• Roxithromycin (Rulid)

These antibiotics are effective against atypical bacteria such as mycoplasma and chlamydia. All but erythromycin are effective against H. influenzae. Macrolides and azalides are also used in some cases for S. pneumoniae and M. catarrhalis, but there is increasing bacterial resistance to these medicines.

Tetracyclines

Tetracyclines inhibit the growth of bacteria. They include doxycycline, tetracycline, and minocycline. They can be effective against S. pneumoniae and M. catarrhalis, but bacteria that are resistant to penicillin are also often resistant to doxycycline. The side effects of tetracyclines include skin reactions to sunlight, burning in the throat, and tooth discoloration.

Trimethoprim-Sulfamethoxazole

Trimethoprim-sulfamethoxazole (such as Bactrim, Cotrim, and Septra) is less expensive than amoxicillin and particularly useful for adults with mild bacterial upper respiratory infections who are allergic to penicillin. The drug is no longer effective against certain streptococcal strains. It should not be used in patients whose infections occur after dental work, or in people who are allergic to sulfa drugs. Allergic reactions can be very serious.

Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).