Considerations in managing CAP in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis

The most common pathogens that cause community-acquired pneumonia (CAP) in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis are the same as in adults without comorbid lung disease (eg Streptococcus pneumoniae). Because of frequent infections and antibiotic exposure, sputum culture results may identify multidrug-resistant bacteria in these patients; however, these bacteria are more likely to be colonising organisms rather than the cause of CAP.

Note: The usual pathogens (eg Streptococcus pneumoniae) are the most common cause of CAP in adults with COPD or bronchiectasis.

For adults with COPD or bronchiectasis who have low- or moderate-severity CAP, no change to standard empirical antibiotic therapy is required. However, the empirical regimen may need to be adjusted for patients with high-severity CAP who are colonised with multidrug-resistant gram-negative pathogens, such as Pseudomonas aeruginosa.

In adults with COPD or bronchiectasis who have CAP, ensure airway clearance strategies are optimised (eg chest physiotherapy).

For antibiotic management of exacerbations of COPD or bronchiectasis, see Antibiotic management of COPD exacerbations or Antibiotic management of bronchiectasis in adults.