title: Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis.
abstract: Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P < 0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; second-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.
authors.affiliation: School of Pharmacy & Allied Health Professions, Creighton University, Omaha, NE 68178, USA. CDestach@creighton.edu
authors.forename: C J
authors.initials: CJ
authors.lastname: Destache
authors.forename: N
authors.initials: N
authors.lastname: Dewan
authors.forename: W J
authors.initials: WJ
authors.lastname: O'Donohue
authors.forename: J C
authors.initials: JC
authors.lastname: Campbell
authors.forename: V A
authors.initials: VA
authors.lastname: Angelillo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin