step1. 看症狀來決定嚴重度以及要不要給anti?

1. increased dyspnea

2. increased sputum purulency

3. increased sputum volume

# 1個 -> mild -> 不用給anti / bronchodilator加量(症狀治療即可)/monitor symptoms

# 2個以上 -> moderate to severe -> 給anti

step2.由poor outcome factor來決定給哪種anti?

1. age>65y/o

2. AE>3times/year

3. coexist cardiac disease

4. FEV1<50%

# 只要有一個以上就算是complicated COPD

Step3.complicated or uncomplicated 各要給哪種anti?

uncomplicated

1. cepha(cefuroxime/cefpodoxime/ceddinir)

2. macrolide(azithromycin/clarithromycin)

3. Doxcyclin

4. SMX-TMP

complicated

1. fluroquinolone(moxifloxacin,gemifloxacin, levofloxacin)

2. Augmentin

3. Ciprofloxacin + sputum culture (if at risk of Pseudomonas)

Step4. Monitor

3天內symptom worsen或inadequate response -> reevaluate + sputum culture

 

 

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