Appropriate outpatient treatment of acute bacterial exacerbations of chronic bronchitis

Fernando J. Martinez, Antonio R Anzueto

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Acute exacerbations of chronic bronchitis (AECB), which are characteristic of chronic obstructive pulmonary disease (COPD), contribute to morbidity and decreased quality of life for patients with COPD. A significant proportion of these exacerbations are due to bacterial infections. The Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria provide guidance for choosing the optimal drug at its optimal dose and duration for antimicrobial treatment of AECB due to bacterial infection. Evidence-based guidelines recommend stratifying patients according to risk factors to improve selection of targeted antimicrobial therapy. With increasing rates of resistance to some antimicrobials, resistance is also an important consideration for reducing treatment failures and decreasing the need for further pharmacologic treatment. Fluoroquinolones are recommended as first-line therapy for patients with chronic bronchitis who have risk factors; gatifloxacin, gemifloxacin, and levofloxacin are highly active against commonly encountered pathogens. Safety profiles are an important consideration because adverse events and poor tolerability can reduce patient adherence rates, which in turn can lead to poorer outcomes. Safety profiles also become an important consideration as shorter-course, higher-dose therapies become more prevalent. First-line therapy with a well-tolerated antibiotic that is active against the predominant pathogens, combined with low resistance rates and a convenient once-a-day dosing regimen, may reduce overall costs. Fluoroquinolones exhibit low resistance, good activity levels, and high respiratory penetration, and they are particularly well suited for shorter-course, higher-dose regimens in selected patients. Shorter-course, higher dose regimens, in turn, may be more effective, cost-efficient, and appropriate for controlling the rise of resistance than standard regimens.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume118
Issue number7 SUPPL.
DOIs
StatePublished - Jul 2005

Fingerprint

Chronic Bronchitis
Outpatients
Fluoroquinolones
Bacterial Infections
Chronic Obstructive Pulmonary Disease
Therapeutics
Anti-Bacterial Agents
Safety
Costs and Cost Analysis
Levofloxacin
Patient Compliance
Treatment Failure
Quality of Life
Guidelines
Morbidity
Pharmaceutical Preparations

Keywords

  • Acute exacerbations of chronic bronchitis
  • Antibiotics
  • Chronic obstructive pulmonary disease
  • Fluoroquinolones
  • Resistance
  • Short-coursetherapy

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Appropriate outpatient treatment of acute bacterial exacerbations of chronic bronchitis. / Martinez, Fernando J.; Anzueto, Antonio R.

In: American Journal of Medicine, Vol. 118, No. 7 SUPPL., 07.2005.

Research output: Contribution to journalArticle

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