Antibiotic Stewardship und chronische Lungenerkrankungen

BACKGROUND: The treatment of acute exacerbations in patients with chronic lung diseases is often associated with the administration of antibiotics. Repeated hospitalization, high antibiotic consumption and the danger of the emergence of multidrug-resistant bacteria represent a major burden for the healthcare system. OBJECTIVE: The purpose of this article is to provide an overview of antibiotic stewardship strategies for the management of patients with chronic lung diseases, with a particular focus on chronic obstructive pulmonary disease (COPD), bronchiectasis and cystic fibrosis (CF). MATERIAL AND METHODS: This review article is based on a literature search in PubMed. RESULTS AND DISCUSSION: Point of care tests (POCT) for faster pathogen detection have yielded inconsistent results in terms of reducing antibiotic treatment. As a relatively simple method, the use of POCT C‑reactive protein (CRP, cut-off < 20 mg/l or ≥ 40 mg/l) could reduce the use of antibiotics in patients with exacerbated COPD without jeopardizing the safety. The value of procalcitonin is still unclear. In cases of nonpurulent sputum and a mild to moderate COPD exacerbation, antibiotic treatment can be omitted in accordance with the guidelines. The use of macrolides leads to an increased development of resistance and harbors the particular danger of cardiac side effects, so that a long-term treatment must be critically viewed in patients despite frequent COPD exacerbations. In CF, the use of cystic fibrosis transmembrane conductance regulator (CFTR) modulators has improved the management of the underlying disease to such an extent that fewer antibiotic treatments are needed. Even in patients with bronchiectasis there is reason to hope that antibiotics can be reduced through new treatments, such as neutrophil elastase inhibitors. Any use of antibiotics in chronic lung diseases should be carried out in accordance with the guidelines.