[Objectives for antibiotic therapy in acute exacerbations of chronic bronchitis].
ANTIBIOTIC EFFICACY: According to early studies, antibiotics have moderate efficacy in acute exacerbation of chronic bronchitis. The lack of efficacy is particularly clear for patent exacerbation with marked alteration of respiratory function. Recent studies have shown that newer compounds exhibit an efficacy similar (no proven superiority) to comparison compounds (75 to 95% favorable outcome with treatment). The recommendations of the IVth Consensus Conference on Anti-infectious Therapy thus propose first line antibiotic therapy for patients with a forced expiratory volume in 1 second (FEV1) between 80 and 35% and broader spectrum and new antibiotics in case of failure of the first line treatment for patients with severe obstruction or frequently recurrent exacerbation.
Using exacerbation-free interval, reduction in the number of exacerbations, duration of treatment and/or hospital stay as evaluation criteria, interesting results are obtained with amoxicillin/clavulanic acid, azithromycin, and ciprofloxacin. Independent factors predictive of therapeutic failure are, according to one study, FEV1 less than 35%, ambulatory administration of oxygen, more than 4 acute exacerbations within 24 months, history of pneumonia or sinusitis, and requirement for long-term corticosteroid therapy. Factors predictive of recurrence are, according to another study, dependence on oxygen therapy, prolonged corticosteroid therapy, smoking, and/or heart disease. Cost effectiveness is particularly interesting with ciprofloxacin, especially in more severe patients.


CONCLUSIONS
It is important to target antibiotic therapy for acute exacerbation of chronic bronchitis specifically for patients who will truly benefit, adapting the prescribed compound to the bacterial target.
Gaillat
J
J
Service des maladies infectieuses, Centre hospitalier de la région Annecienne, Annecy.
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D029481:Bronchitis, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008449:Maximal Expiratory Flow-Volume Curves; D015337:Multicenter Studies as Topic; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D010919:Placebos; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012008:Recurrence; D012129:Respiratory Function Tests; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D010406:Penicillins; D010919:Placebos; D019818:Clavulanic Acid; D002939:Ciprofloxacin; D004917:Erythromycin; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin; D013752:Tetracycline