Antibiotics in acute exacerbations of chronic bronchitis

Abstract

Acute exacerbations of chronic bronchitis (AECB) are a major contributor to morbidity and mortality in patients with chronic obstructive pulmonary disease, accounting for more than 16 million physician office visits and over 500,000 hospitalizations in the USA each year. Antimicrobials have been recognized by clinical guidelines as an important component in the management of AECB with a bacterial etiology. The challenge of identifying patients most likely to benefit from antimicrobial therapy is difficult in the clinical setting. However, appropriate risk stratification of patients, and the use of antimicrobials within the correct spectrum and for a suitable duration, can improve clinical outcomes while minimizing induction of antimicrobial resistance. With an improved design in pharmacologic and clinical studies, differences can be appreciated among the various antimicrobial agents available to treat AECB. Factors to be considered in antimicrobial agent selection include local tissue penetration, effects on bacteriological eradication, duration of therapy, speed of resolution and prevention or delay of recurrences.

Keywords::

• antimicrobial resistance
• chronic bronchitis
• COPD
• exacerbation
• Haemophilus influenzae
• Moraxella catarrhalis
• Streptococcus pneumoniae

Financial & competing interests disclosure

The author has received research support, honoraria or consulting fees from Bayer, Cornerstone, Glaxo Smith Kline, Mpex, Pfizer, Sanofi-Aventis and Schering. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The author would like to acknowledge the editorial assistance of Shabber Abbas in the preparation of this manuscript. Support for this assistance was provided by Schering-Plough, Corporation. The author accepts full responsibility for the construction and authorship of this manuscript. No other writing assistance was utilized in the production of this manuscript.