Antibiotic therapy in elderly patients with acute exacerbation of chronic bronchitis

Abstract

Chronic bronchitis (CB) is a critical component of chronic obstructive pulmonary disease (COPD). Emphysema, reversible airway disease and bronchiectasis also contribute to COPD. Elderly patients are at increased risk for COPD and its components – emphysema, CB and bronchiectasis. In addition, older patients are at increased risk for resistant organisms during episodes of acute exacerbation of CB (AECB). These organisms include the more common bacteria implicated in AECB, such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae, and less common nonenteric, Gram-negative organisms such as Pseudomonas aeruginosa. Risk-stratified antibiotic treatment guidelines for AECB appear to be useful, although they have not been prospectively validated for the general CB population, and especially not in the elderly CB population. Many of the AECB treatment guidelines that are stratified based on risk factors have recommended that the oral respiratory fluoroquinolone antibiotics (gemifloxacin, levofloxacin and moxifloxacin) play a second-line but pivotal role, particularly in patients who have failed initial antibiotic treatment for simple CB or as initial treatment for complicated CB.

Keywords::

• bronchiectasis
• bronchitis
• COPD
• elderly patients

Financial & competing interests disclosure

The authors accept full responsibility for the contents of this manuscript. Timothy E Albertson is on the Speakers Bureaus for BI and GSK (COPD), Schering Plough (AECB) and has funded research from Pfizer (hospital pneumonia). Andrew L Chan is on the Speakers Bureau for the France Foundation (Intermune IPF). The authors have 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 authors would like to acknowledge the editorial assistance of Ching-Ling Chen, PhD, in the preparation of this manuscript. Support for this assistance was provided by Schering-Plough Corporation.

No other writing assistance was utilized in the production of this manuscript.