Rising to the challenge of resistance: a case study-based discussion

Physicians treating patients with lower respiratory tract infections face numerous challenges and treatment decisions. For example, when treating a patient with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), a physician must determine: (1) whether the patient should be hospitalised; (2) the cause of the exacerbation; (3) whether bacterial infection is present; and (4) which antibacterial agent should be used (if antibacterial treatment is required). In this article, the key challenges faced by physicians treating patients with AECOPD are described and illustrated using a case study. The impact of antibiotic resistance and other factors influencing a physician's treatment decisions are discussed, and current evidence and guidelines which should inform these decisions are reviewed.