Treatment of acute bacterial exacerbations of chronic bronchitis.
BACKGROUND
Controversies persist regarding the optimal management of patients with acute exacerbations of chronic bronchitis (AECB).


OBJECTIVE
To evaluate the available evidence on relevant issues, namely the need for administering antimicrobials in patients with AECB, the identification of the subgroup of patients with AECB needing antibiotics, the antimicrobial regimen of choice and its optimal duration, the existence of new agents, and the value of non-antimicrobial regimens for AECB.


METHODS
Data from various sources of evidence, including recent relevant meta-analyses, were appraised.


CONCLUSIONS
Administration of antimicrobial agents, combined with bronchodilators and systemic corticosteroids, is warranted in approximately half of AECBs (i.e., in bacterial exacerbations) to achieve a survival benefit. Simple clinical parameters, mainly sputum purulence, and biomarkers, such as procalcitonin, are useful in identifying patients requiring antibiotics. Advanced antibiotics (quinolones, macrolides, or amoxicillin/clavulanic acid) are more effective than 'old' antibiotics in AECB; regimens of short duration (for 5 days) are preferred. There is no difference between several classes of advanced antibiotics regarding their short-term effectiveness; however, quinolones are associated with better long-term outcomes than macrolides. Newer quinolones and new formulations of macrolides enrich clinicians' armamentarium against AECB.
Siempos
Ilias I
II
Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
Michalopoulos
Argyris
A
Falagas
Matthew E
ME
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D017050:Episode of Care; D006801:Humans
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents