The old Anthonisen criteria are often used to select patients in whom antibiotic treatment is necessary. Are these criteria evidence-based? What about patients without purulent sputum but with fever? Should we rather use antibiotics as a standard treatment in all exacerbations?
Jadwiga Wedzicha, MD: I think the issue of antibiotics in exacerbations is interesting. First of all, when the Anthonisen criteria are fulfilled—so that is more shortness of breath, increased sputum volume, or change in sputum color—the evidence base for antibiotics is actually pretty good to date across the disease spectrum of chronic obstructive pulmonary disease (COPD).
I think there are 2 questions. What do you do when a patient with COPD comes in with a fever? I think that patient needs investigation. Is it a pneumonia? If it is a pneumonia, yes, you will treat with antibiotics. Is there a viral infection? Viral infections per se will not respond to antibiotics. I think that we have to, at the moment, use our clinical judgment on this. I think in the future we will have diagnostic tests for the presence of infection. Although they are used in research settings, they are not really useful yet in general medical practice.