Manage acute infections in patients taking chronic antibiotics
Questions are coming up about how to manage acute infections in patients taking chronic antibiotics. A common scenario is a patient taking an antibiotic to prevent a recurrent UTI or COPD exacerbation or to treat acne, who needs a new antibiotic for an acute infection. Use antimicrobial stewardship principles and these rules of thumb...
Help re-evaluate the need for a chronic antibiotic. Stopping it altogether may reduce the risk of resistance, C. difficile infections, and potentially avoid interactions and additive side effects. For example, generally suggest stopping TMP/SMX if a woman is taking it to prevent recurrent UTIs, but hasn't had a UTI in a year.
For ACUTE infections, suggest holding the chronic antibiotic in most cases if it can't be stopped completely. Suggest using an antibiotic from a different class to treat the acute infection, since patients on chronic antibiotics may have resistant or atypical organisms. For example, if a COPD patient using azithromycin (Zithromax) three times per week develops pneumonia, consider a quinolone like levofloxacin (Tavanic) instead of a macrolide plus a beta-lactam. Watch for exceptions. For example, suggest continuing chronic antibiotics for Pneumocystis pneumonia prophylaxis in an HIV patient.
References
- Pomares X, Montón C, Bullich M, Cuevas O, Oliva JC, Gallego M, Monsó E. Clinical and Safety Outcomes of Long-Term Azithromycin Therapy in Severe COPD Beyond the First Year of Treatment. Chest. 2018 May;153(5):1125-1133.
- Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, et al. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Respirology. 2017 Apr;22(3):575-601.
This note has been edited and reviewed by the pharmacy doctors on NPS team.
- Published on February 09, 2022
- This note last updated in March 13, 2025
