Documento de consenso sobre el diagnóstico y tratamiento de la infección bronquial crónica en la enfermedad pulmonar obstructiva crónica

Rosa, David de la; Lόpez-Campos, José Luís; Navarrete, Bernardino Alcázar; Rubio, Myriam Calle; Moreno, Rafael Cantón; García-Rivero, Juan Luis; Carro, Luís Máiz; Fuster, Casilda Olveira; Martínez‐García, Miguel Ángel; Callejas, Francisco Javier; Juan, Ángela Cervera; Cervera, Marta Palop; Gomila, Antonia Fuster; Tapia, Alicia Marín; Pomares, Xavier; González, Mirian Torres; Borge, Jacinto Hernández; Chica, Gerardo Pérez; Galván, Rocío Jimeno; Gómez, Rafael Golpe; Rodríguez, Pedro J. Marcos; Rivas, Pilar Cebollero; Huguet, Eva Tabernero; Martínez, Carlos Álvarez; Sánchez, Concha; Garcerán, José Javier Martínez; Mellado, Carlos Peñalver; Clemente, Marta García; López, Juan Rodríguez; Gonçálves, Juan Marco Figueira; Mendoza, Guillermo José Pérez; Hernández, Jesús Hernández; Diago, Carlos Amado; Giménez, Laura Pérez; Álvarez, Virginia Moya; Rotger, Alexandre Palou; Moreno, Rosa Girón; Aparicio, Marina Blanco; Navarro, Annie; Sibila, Oriol; Fernández, Marc Miravitlles; Cataluña, Juan José Soler; Villar, José Alberto Fernández; Romero, Germán Peces-Barba

doi:10.1016/j.arbres.2020.04.023

Cited by 39 publications

(5 citation statements)

References 121 publications

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“…Las pautas más empleadas incluyeron doxiciclina (39%), amoxicilina-clavulánico (20%), azitromicina (14%) o amoxicilina (10%) [25]. En España, las diferentes recomendaciones estratifican la elección del antimicrobiano en función de la gravedad y los microorganismos esperados [7,9,26]. En todos los casos, amoxicilina, sola o en asociación con ácido clavulánico, es la recomendación que aparece como primera elección, siendo cefditoreno, cefalosporina oral de tercera generación, y las quinolonas, tratamientos alternativos.…”

Section: Microorganismos Más Frecuentes En La Infección Respiratoria unclassified

“…Es de resaltar que las guías actuales aún no recogen las alertas emitidas por las agencias reguladoras (FDA y EMA) sobre el riesgobeneficio del tratamiento con las fluoroquinolonas. Asimismo, azitromicina no ocupa un lugar preferente y su uso se ajusta más a su valor inmunomodulador a largo plazo que a su efecto antimicrobiano [26]. En el caso de la infección bronquial crónica se recomienda tratamiento con antibioterapia inhalada en caso de aislarse P. aeruginosa.…”

Section: Microorganismos Más Frecuentes En La Infección Respiratoria unclassified

“…En la tabla 1 se recogen los antibióticos indicados en las diferentes guías según la situación clínica del paciente y el microorganismo esperado o aislado o detectado en el estudio microbiológico [7,9,26,27].…”

Section: Microorganismos Más Frecuentes En La Infección Respiratoria unclassified

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Current microbiological aspects of community respiratory infection beyond COVID-19

Cantón

2021

Rev Esp Quimioter

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From a microbiological point of view, both empirical and targeted antimicrobial treatment in respiratory infection is based on the sensitivity profile of isolated microorganisms and the possible resistance mechanisms that they may present. The latter may vary in different geographic areas according to prescription profiles and vaccination programs. Beta-lactam antibiotics, fluoroquinolones, and macrolides are the most commonly used antimicrobials during the exacerbations of chronic obstructive pulmonary disease and community-acquired pneumonia. In their prescription, different aspects such as intrinsic activity, bactericidal effect or their ability to prevent the development of resistance must be taken into account. The latter is related to the PK/PD parameters, the mutant prevention concentration and the so-called selection window. More recently, the potential ecological impact has grown in importance, not only on the intestinal microbiota, but also on the respiratory one. Maintaining the state of eubiosis requires the use of antimicrobials with a low profile of action on anaerobic bacteria. With their use, the resilience of the bacterial populations belonging to the microbiota, the state of resistance of colonization and the collateral damage related to the emergence of resistance to the antimicrobials in pathogens causing the infections and in the bacterial populations integrating the microbiota.

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Section: Microorganismos Más Frecuentes En La Infección Respiratoria unclassified

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Current microbiological aspects of community respiratory infection beyond COVID-19

Cantón

2021

Rev Esp Quimioter

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“…The presence of a chronic bronchial infection in COPD is of special interest. 69 This clinical situation has been associated with the presence of bronchiectasis. However, recent evidence has shown that COPD patients may have a chronic bronchial infection that causes a major clinical impact and which affects the progression of the disease without the presence of bronchiectasis.…”

Section: Continuing Escalation: Clinical Approaches For Non-respondentsmentioning

confidence: 99%

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a deescalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.

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“…There are no recommendations for their use in the current guidelines for COPD, however, owing to the limited data on their effectiveness in this disease. Nevertheless, there is a consensus document that proposes the administration of inhaled antibiotics in patients with COPD and CBI due to P. aeruginosa or other particularly virulent PPM [15].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

Rosa

Suárez-Cuartín

Sibila

et al. 2023

JCM

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The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics.

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Documento de consenso sobre el diagnóstico y tratamiento de la infección bronquial crónica en la enfermedad pulmonar obstructiva crónica

Cited by 39 publications

References 121 publications

Current microbiological aspects of community respiratory infection beyond COVID-19

Current microbiological aspects of community respiratory infection beyond COVID-19

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

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