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
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. 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. Available at: https://onlinelibrary.wiley.com/doi/10.1111/resp.13012