Lower
respiratory tract infections are the leading cause of
infectious disease deaths worldwide and are the fifth leading cause of death overall. This is despite conditions such as
pneumococcal infections and
influenza being largely preventable with the use of appropriate
vaccines. The mainstay of treatment for the most important bacterial lower
respiratory tract infections, namely acute exacerbations of
chronic obstructive pulmonary disease (AECOPD) and community-acquired
pneumonia (CAP), is the use of
antibiotics. Yet despite a number of recent publications, including clinical studies as well as several systematic literature reviews and meta-analyses, there is considerable ongoing controversy as to what the most appropriate
antibiotics are for the empiric
therapy of CAP in the different settings (outpatient, inpatient, and intensive care unit). Furthermore, in the case of AECOPD, there is a need for consideration of which of these exacerbations actually need
antibiotic treatment. This article describes these issues and makes suggestions for appropriately managing these conditions, in the setting of the need for antimicrobial stewardship initiatives designed to slow current emerging rates of antibiotic resistance, while improving patient outcomes.