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COPD patients are more susceptible to respiratory infections, and vulnerable to severe consequences from them. Frequent unchecked lung infections can accelerate pulmonary destruction in all these patients, and precipitate a life-threatening crisis in advanced cases. So it is critical for COPD patients to protect themselves against airway infections. Avoidance measures minimize their number. Control measuresmeaning the most effective use of antibioticsminimize the impact of those airway infections that can't be prevented.

Arrival of a chest infection is always heralded by warning signs: malaise, easier fatigability, worsening dyspnea, fever, nasal congestion, increased coughing combined with more difficult expectoration (clearing the mucus out) as the mucus becomes yellow or green and much more viscous. These infections are typically caused by certain bacteria (Haemophilus influenza, Streptococcus pyogenes, Diplococcus pneumonia, Klebsiella pneumonia) and/or viruses (influenza, adenovirus, respiratory syncytial virus).

Because these airway infections are a major cause of exacerbated symptoms for a COPD patientespecially one with substantial chronic bronchitisit is critical to control them. This is done with appropriate medication. Antibioticsalso called antimicrobialsis the general term for agents used to treat infection. Since microbes come in two different kinds, so do antibiotics: antibacterial and antiviral. In common use, though, people interchange antibiotic and antibacterial.

A Brief History

The very first drug used to treat pulmonary infections were the sulfonamides. The German dye industry actually developed them, at the turn of the century, in its search for better color fastness. The sulfonamides were highly successful dyes because they bonded to wool and silk proteins. Some observant medical researchers of the day wondered if these new dyes might also react with bacterial proteins. The first medical report on the sulfonamides, in 1913, found them effective against pneumococcal and staphylococcal bacteria.

In 1928, London scientist Alexander Fleming accidentally discovered that something in the common greenish-colored Penicillium notatum mold kills bacteria. Eleven years later at Oxford, H. W. Florey finally isolated the actual "bactericidal" substance from this mold. Although the yield from this process was tiny, he eventually accumulated enough penicillin to treat a patient desperately ill with staphylococcal and streptococcal infections. The patient lived.

The decades since Florey first used penicillin to save a life have seen proliferation in two related directions. On the one hand, bacteria have shown that they can alter the aspect of their structure that is vulnerable to a particular antibiotic. So bacterial strains now exist that are resistant to all but the newest drugs. Also, as pharmaceutical companies continue their battle to regain the forefront, they are coming up with both new types of antibiotics and improved versions of older ones.

How to Use

You should start your prescribed antibiotic quicklyno more than 24 hours after you first notice the early signals of a chest infection: a lot more coughing and mucus, with mucus becoming yellow to green. So call your doctor right away. (Don't delay because you fear not having an infection and wasting his time. If you have chosen your doctor well, he prefers risking a few minutes of his time over the consequences to you of failing to control a respiratory infection.) Then follow your doctor's instructions for letting him know your progressor lack of improvementand for taking your medication.

As long as there is no reason to switch your antibiotic, your doctor will have you take it for one week to ten days. But if your infection does not improve quickly, most likely the bacteria causing it is not highly vulnerable to this antibiotic. Your doctor will prescribe a different antibiotic, and he may also send a sample of your sputum to the pathology laboratory for "culture and sensitivity" tests. "Culturing" the bacteria in your sputum means growing them until the different bacterial groups, or colonies, become large enough to be identified under the microscope. "Sensitivity" testing determines the antibiotic(s) most lethal to these particular bacteria. These tests take time, yet you must continue taking an antibiotic. So your doctor will combine knowledge and instincts to choose an alternative, revising this choice only if necessary once the results are in.

Several types of antibiotics effectively subdue the COPD patient's typical lung infections: the main ones are the penicillinsalso called betalactams (such as Ampicillin), the macrolides (such as Biaxin), the cephalosporins (such as Keflex), the fluoroquinolones (such as Cipro), and the compound antibiotic trimethoprim-sulfamethoxazole (called Bactrim or Septra). Each type of antibiotic attacks bacteria in a different way.

Although antibiotics can have side effects, they are usually minimal. The most common is some degree of stomach discomfort and/or diarrhea. A small amount of food (crackers are excellent) along with each pill can calm a distressed stomach for some. Diarrhea can occur because bactericidal drugs often destroy helpful as well as dangerous microbes. This includes friendly bacteria that live in our large intestine and regulate the consistency of our bowel movements. Yogurt, however, contains these same helpful bacteria if it hasn't been cooked at too high a temperature. So a daily portion of bacteria-containing yogurt for the duration of antibiotic therapy usually minimizes or stops diarrhea. In fact, many doctors now instruct their patients to add yogurt to their diet as soon as they begin an antibiotic. It is critical, though, to choose a brand of yogurt that states "live cultures" clearly on the container. Most such brands contain one or two of the bacteria your intestines need.

Note: Your stomach contents can interfere with antibiotic absorption into your system. Try to schedule meals, milk, and/or antacid use to come at least one hour after taking an antibiotic dose, or two hours before. If you are unsure about this food-medication separation for a particular antibiotic, check with your pharmacist. If your eating pattern makes it difficult to coincide antibiotic medication with an adequately empty stomach, let your doctor know. He may be able to prescribe an equally effective antibiotic that does not require an empty stomach.

It is important for those of you who take theophylline to know that some antibiotics will slow its removal. Ask your doctor about this possibility if he prescribes an antibiotic that you have not taken before. If you ever do find yourself having to take an antibiotic that is going to increase the theophylline level in your blood, be alert for early signs of theophylline toxicity: irritability, restlessness, nausea. If they appear, do not take your next theophylline dose; do call your doctor immediately.

You may not initially recognize these theophylline toxicity symptoms. But as they intensify to severe insomnia, agitation and vomiting, it becomes difficult to mistake them for anything benign. Do not take your next theophylline dose. Do get immediate medical help. If your doctor is unavailable, go to the emergency room at the hospital where he is affiliated.


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