From the Guidelines
The Anthonisen criteria for antibiotic treatment in COPD exacerbations include patients with all three symptoms of increased dyspnea, sputum volume, and sputum purulence (Type I), patients with two symptoms including increased purulence (Type II), and those requiring mechanical ventilation. The Anthonisen criteria are clinical guidelines used to identify acute exacerbations of chronic obstructive pulmonary disease (COPD) and determine their severity, as outlined in the 2011 guidelines for the management of adult lower respiratory tract infections 1. These criteria consist of three cardinal symptoms:
- increased dyspnea (shortness of breath)
- increased sputum volume
- increased sputum purulence (change in color to yellow or green) The severity is classified based on how many of these symptoms are present:
- Type 1 (severe) exacerbation includes all three symptoms
- Type 2 (moderate) includes two of the three symptoms
- Type 3 (mild) includes one or none of the above symptoms These criteria help clinicians determine when antibiotic therapy is appropriate, with Type 1 exacerbations generally warranting antibiotics, Type 2 sometimes requiring antibiotics (especially if purulent sputum is present), and Type 3 typically not requiring antibiotics unless there are complications, as supported by the European Respiratory Journal guidelines 2. The Anthonisen criteria remain valuable in clinical practice because they provide a standardized approach to assessing COPD exacerbations and guide appropriate treatment decisions, with the most recent guidelines from 2011 providing the basis for current clinical practice 1.
From the Research
Anthonisen Criteria
The Anthonisen criteria are used to determine when antibiotic treatment is indicated for acute exacerbations of chronic bronchitis (AECB) 3, 4, 5. The criteria are based on the presence of certain symptoms and risk factors.
Symptoms
The Anthonisen criteria include three key symptoms:
- Increased dyspnea
- Increased sputum production
- Increased sputum purulence
Risk Factors
The criteria also include several risk factors, such as:
- Age ≥ 65 years
- Forced expiratory volume in 1 second (FEV1) < 50% of the predicted value
- ≥ 4 AECBs in 12 months
- ≥ 1 comorbidity
Classification
The Anthonisen criteria classify AECB into three types:
- Type 1: Increased dyspnea, increased sputum production, and increased sputum purulence
- Type 2: Two of the above symptoms
- Type 3: One of the above symptoms
- Type 1 exacerbations are considered the most severe and are typically treated with antibiotics 4, 5.
Antibiotic Treatment
Antibiotic treatment is generally recommended for patients with Anthonisen Type 1 exacerbations, as well as those with certain risk factors, such as age ≥ 65 years, FEV1 < 50%, or ≥ 4 AECBs in 12 months 3, 6. The choice of antibiotic should be based on the likely pathogens, resistance patterns, and individual patient factors 7, 6.