S. pneumoniae, H. influenzae and Moraxella cartarrhalis are the most usually identified causes of secondary bacterial infection in COPD.
Typically, a course of treatment should be at least five days. A response is usually seen within three to five days, and a change of antibiotic should be considered if the response is unsatisfactory. If parenteral administration was commenced, oral treatment should be substituted within 72 hours. An historical population-based cohort study ( Roede 2008 ) [evidence level III-2] found that co-treatment of an exacerbation with oral corticosteroids and oral antibiotics significantly increased the time to subsequent exacerbations (median 312 versus 418 days, p< to next compared to oral corticosteroids alone).
To minimize the risk of glucocorticoid-induced bone loss, should use the smallest possible effective dosage and duration and use topical and inhaled preparations whenever possible. Obtain baseline measurement of bone mineral density (BMD) at the lumbar spine and/or hip when initiating long-term (., exceeding 6 months) glucocorticoid therapy and initiate appropriate preventive therapy. May repeat longitudinal measurements as often as every 6 months to detect possible bone loss. Less frequent (., annually) follow-up probably is sufficient in patients who are receiving therapy to prevent bone loss.