Can a 72-year-old patient with Chronic Obstructive Pulmonary Disease (COPD) and a diagnosis of Streptococcal (strep) infection, experiencing a COPD exacerbation, be treated with corticosteroids (steroids) and antibiotics (abx)?

From the Guidelines

Yes, you can give steroids along with antibiotics for a 72-year-old COPD patient experiencing an exacerbation with strep infection. The recommended approach would be to start oral prednisone at 40mg daily for 5 days, along with an appropriate antibiotic for strep such as amoxicillin 500mg three times daily for 7-10 days or azithromycin 500mg on day 1 followed by 250mg daily for 4 more days if the patient has a penicillin allergy. Steroids are a cornerstone of COPD exacerbation treatment as they reduce airway inflammation, decrease mucus production, and improve airflow, as supported by recent guidelines 1. The concern about giving steroids with an infection is that they may suppress the immune response, but in COPD exacerbations, the benefits of steroids typically outweigh this risk, especially when appropriate antibiotics are administered simultaneously 1. Ensure the patient completes the full course of antibiotics even if symptoms improve quickly. Monitor for side effects including elevated blood glucose in diabetic patients, and consider gastric protection with a proton pump inhibitor if the patient has a history of peptic ulcer disease. Key considerations in managing COPD exacerbations include the use of systemic corticosteroids and antibiotics when indicated, as well as ensuring the patient's maintenance therapy is optimized to prevent future exacerbations 1. The choice of antibiotic should be based on local resistance patterns, affordability, and patient history and preferences, with amoxicillin and azithromycin being common choices for strep infections 1. Overall, the goal is to minimize the negative impact of the current exacerbation and prevent subsequent events, improving the patient's quality of life and reducing morbidity and mortality associated with COPD exacerbations 1.

From the FDA Drug Label

Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection

The patient has a bacterial infection (strep) and is having a COPD exacerbation. Considering the patient's condition, steroids may be given with antibiotics (abx) to help manage the COPD exacerbation, but it is crucial to monitor for the development of infection and consider prednisone tablets withdrawal or dosage reduction as needed 2. However, the decision to give steroids should be made with caution, taking into account the potential risks of immunosuppression and increased risk of infection.

• Key considerations:
  • Monitor for signs of infection
  • Consider prednisone tablets withdrawal or dosage reduction as needed
  • Weigh the benefit-risk ratio for each patient in whom corticoid therapy is being considered 2

From the Research

Treatment of COPD Exacerbation with Steroids and Antibiotics

• The use of steroids, such as corticosteroids, in the treatment of COPD exacerbation is a common practice, as it helps to reduce inflammation in the airways 3.
• In the case of a 72-year-old patient with COPD, diagnosed with strep, and experiencing a COPD exacerbation, the use of steroids with antibiotics may be beneficial 3, 4.
• The choice of antibiotic should be based on the severity of the exacerbation, the patient's medical history, and the risk of resistant bacterial organisms 4.
• Studies have shown that the use of antibiotics, such as macrolides, quinolones, and tetracyclines, can help to reduce the frequency and severity of COPD exacerbations 5, 6.
• However, the long-term use of antibiotics is associated with an increased risk of adverse events, such as antimicrobial resistance, and should be used judiciously 5, 6, 7.

Considerations for Treatment

• The patient's age, medical history, and the severity of the exacerbation should be taken into account when deciding on the treatment plan 4.
• The use of inhaled corticosteroids in patients with COPD and chronic bronchial infection may increase the risk of pneumonia, and should be used with caution 5.
• The benefits and risks of long-term antibiotic therapy should be carefully weighed, and the treatment plan should be individualized based on the patient's needs and medical history 5, 6, 7.