Acute exacerbation of chronic bronchitis: Identifying patients who will benefit from antibiotic therapy

The role of bacterial infection and the use of antibiotics in acute exacerbation of chronic bronchitis are controversial. High-risk patients in whom the cost of clinical treatment failure is high and in whom antibiotics may be expected to produce a favorable outcome can be identified by simple clinical criteria. Stratification of patients according to disease severity will not only aid clinical management but will also allow more relevant information to be derived from future clinical studies. When selecting an antibiotic for treatment of an infectious episode, one must consider underlying patient co-morbidities, likely pathogens, local patterns of antibiotic resistance, and individual antibiotic properties. The choice of agents has greatly expanded, and newer antibiotics, such as the quinolones and macrolides, offer several therapeutic advantages over traditional compounds. These agents are recommended as a first-line choice in high-risk patients in whom therapeutic failure can have severe personal and economic consequences.