TABLE 2.

RECOMMENDATIONS REGARDING TIMING OF ANTIMICROBIAL THERAPY IN RECENT SPECIALTY-SOCIETY RECOMMENDATIONS

Guideline Source, Year (Reference)	Recommendation*
Canadian Thoracic Society, 2003 (143)	“The Panel proposes that antibiotics should only be considered for use in patients with purulent exacerbations.”
American Thoracic Society/European Respiratory Society, 2004 (169)	“[Antibiotics] may be initiated in patients with altered sputum characteristics.”
National Institute for Clinical Excellence, 2004 (107)	“Antibiotics should be used to treat exacerbations of COPD associated with a history of more purulent sputum.”
European Respiratory Society, 2005 (170)	“[Hospitalized patients with COPD exacerbations should receive antibiotics if]
	I. Patients with all three of the following symptoms: increased dyspnea, sputum volume and sputum purulence (a type I Anthonisen exacerbation).
	II. Patients with only two of the above three symptoms (a type II Anthonisen exacerbation) when increased purulence of sputum is one of the two cardinal symptoms.
	III. Patients with a severe exacerbation that requires invasive or non-invasive mechanical ventilation.
	IV. Antibiotics are generally not recommended in Anthonisen type II without purulence and type III patients (one or less of the above symptoms).”
GOLD, 2006 (144)	“Antibiotics are only effective when patients with worsening dyspnea and cough also have increased sputum volume and purulence.”

Definition of abbreviation: GOLD = Global Initiative for Chronic Obstructive Lung Disease.

^*Italics added for emphasis.