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Targeted vs Anti-Pseudomonal AECOPD — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipTargeted vs Anti-Pseudomonal AECOPDSCE Infectious Diseases

A 60-year-old man with COPD and bronchiectasis develops an infective exacerbation. He has a history of Pseudomonas colonisation but recent sputum grew only Haemophilus influenzae (beta-lactamase negative). Per NICE guidelines, what is the appropriate antibiotic?

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Correct answer: A — Amoxicillin directed at the current Haemophilus isolate

An important stewardship point: patients with chronic Pseudomonas colonisation do NOT require anti-pseudomonal therapy for every exacerbation. If the current exacerbation pathogen is a non-Pseudomonas organism (H. influenzae in this case), targeted therapy against the current pathogen is appropriate. Anti-pseudomonal escalation is reserved for exacerbations where Pseudomonas is the isolated pathogen or when clinical response to non-pseudomonal antibiotics fails. This prevents unnecessary broad-spectrum use.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections