Infection and Antibiotic Treatment in Acute Exacerbations of Chronic Bronchitis

  • M. S. Niederman


Patients with chronic bronchitis commonly have disease exacerbations, characterized by any or all of three “cardinal symptoms”: increased dyspnea, increased sputum volume and increased sputum purulence. In one study, Anthonisen and colleagues graded exacerbations as type I if all three symptoms were present, type II if only two symptoms were present, and type III if only one symptom was present [1]. Although bacterial infection may be responsible for exacerbations, and antibiotics are commonly prescribed, this type of therapy remains controversial, particularly since only half of all exacerbations are bacterial in origin, the rest being viral or chemical. Thus, some believe that antibiotic therapy of acute exacerbations of chronic bronchitis (AECB) is an abuse of antibiotics, and can contribute to antimicrobial resistance. However, a recent meta-analysis has concluded that antibiotics are of benefit, and available data show that this benefit is most clear in patients who have at least two of the three cardinal symptoms of exacerbation [2].


Chronic Obstructive Pulmonary Disease Minimum Inhibitory Concentration Chronic Obstructive Pulmonary Disease Patient Acute Exacerbation Chronic Bronchitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anthonisen NR, Manfreda J, Warren CPW, et al. (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106:196–204PubMedGoogle Scholar
  2. 2.
    Saint S, Bent S, Vittinghoff E, Grady D (1995) Antibiotics in chronic obstructive pulmonary disease exacerbations: A meta-analysis. JAMA 273:957–960PubMedCrossRefGoogle Scholar
  3. 3.
    American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152:S77–S120Google Scholar
  4. 4.
    Baiter MS, Hyland RH, Low DE, Renzi PM, et al. (1994) Recommendations on the management of chronic bronchitis: A practical guide for Canadian physicians. Can Med Assoc J 151(10)(Suppl):5–23Google Scholar
  5. 5.
    Ball P, Harris JM, Lowson D, et al. (1995) Acute infective exacerbations of chronic bronchitis. Q J Med 88:61–68Google Scholar
  6. 6.
    Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R (1999) Treatment cost of acute exacerbations of chronic bronchitis. Clin Ther 21:576–591PubMedCrossRefGoogle Scholar
  7. 7.
    Chodosh S (1991) Treatment of chronic bronchitis: state of the art. Am J Med 91(6A):87S–92SPubMedCrossRefGoogle Scholar
  8. 8.
    Fagon JY, Chastre J, Trouillet JL, et al. (1990) Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis: Use of the protected specimen brush technique in 54 mechanically ventilated patients. Am Rev Respir Dis 142:1004–1008PubMedGoogle Scholar
  9. 9.
    Smith CB, Golden C, Klauber MR, et al. (1976) Interaction between viruses and bacteria in patients with chronic bronchitis. J Infect Dis 134:552–561PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson R (1995) Outcome predictors in bronchitis. Chest 108:53S–57SPubMedCrossRefGoogle Scholar
  11. 11.
    Murphy TF, Sethi S (1992) Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis 146:1067–1083PubMedGoogle Scholar
  12. 12.
    Ball P (1995) Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 108:43S–52SPubMedCrossRefGoogle Scholar
  13. 13.
    Allegra L, Grassi C, Grossi, et al. (1991) Ruolo degli antibiotici nel trattamento delle riacutizza della bronchite cronica. Ital J Chest Dis 45:38–48Google Scholar
  14. 14.
    Baigelman W, Chodosh S, Pizzuto D, et al. (1979) Quantitative sputum Gram stains in chronic bronchial disease. Lung 156:265–270PubMedCrossRefGoogle Scholar
  15. 15.
    Monso E, Ruiz J, Rosell A, et al. (1995) Bacterial infection in chronic obstructive pulmonary disease: A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med 152:1316–1320PubMedGoogle Scholar
  16. 16.
    Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, et al. (1998) Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 157:1498–1505PubMedGoogle Scholar
  17. 17.
    Doern GV, Brueggemann AB, Pierce G, Holley HP. Jr, Rauch A (1997) Antibiotic resistance among clinical isolates of Haemophilus influenzae in the United States in 1994 and 1995 and detection of beta-lactamase-positive strains resistant to amoxicillin-clavulanate: results of a national multicenter surveillance study. Antimicrob Agents Chemother 41:292–297PubMedGoogle Scholar
  18. 18.
    Doern GV, Brueggemann AB, Pierce G, Hogan T, Holley HP. Jr, Rauch A (1997) Prevalence of antimicrobial resistance among 723 outpatient clinical isolates of Moraxella catarrhalis in the United States in 1994 and 1995: Results of a 30-center national surveillance study. Antimicrob Agents Chemother 40:884–2886Google Scholar
  19. 19.
    Clavo-Sänchez AJ, Girón-Gonzälez JA, López-Prieto D, et al. (1997) Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study. Clin Infect Dis 24:1052–1059PubMedCrossRefGoogle Scholar
  20. 20.
    Ewig S, Ruiz M, Torres A, Marco F, Martinez JA, Sanchez M, Mensa J (1999) Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 159:1835–1842PubMedGoogle Scholar
  21. 21.
    Eller J, Ede A, Schaberg T, Niederman MS, Mauch H, Lode H (1998) Infective exacerbations of chronic bronchitis: Relation between bacteriologic etiology and lung function. Chest 113:1542–1548PubMedCrossRefGoogle Scholar
  22. 22.
    Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M, et al. (1999) Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest 116:40–46PubMedCrossRefGoogle Scholar
  23. 23.
    Mandell LA (1994) Antibiotics for pneumonia therapy. Med Clin North Am 78:997–1014PubMedGoogle Scholar
  24. 24.
    Niederman MS (1997) The principles of antibiotic use and the selection of empiric therapy for pneumonia. In: Fishman A (ed) Pulmonary diseases and disorders, 3rd edn. McGraw-Hill, New York, pp 1939–1949Google Scholar
  25. 25.
    Niederman MS (1998) Treatment of respiratory infections with quinolones. In: Andriole V (ed) The quinolones, 2nd edn. Academic Press, San Diego, pp 229–250Google Scholar
  26. 26.
    Preston SL, Drusano GL, Berman AL, Fowler CL, Chow AT, Dornseif B, Reichl V, Natarajan J, Corrado M (1998) Pharmacodynamics of levofloxacin: a new paradigm for early clinical trials. JAMA 279:125–129PubMedCrossRefGoogle Scholar
  27. 27.
    Anzueto A, Niederman MS, Tillotson GS, and the Bronchitis Study Group (1998) Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: Ciprofloxacin 750 mg BID vs clarithromycin 500 mg BID. Clin Ther 20(5):885–900PubMedCrossRefGoogle Scholar
  28. 28.
    Chen DK, McGeer A, De Azavedo JC, Low DE, et al. (1999) Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 341:233–239PubMedCrossRefGoogle Scholar
  29. 29.
    Honeybourne D (1994) Antibiotic penetration into lung tissues. Thorax 49:104–106PubMedCrossRefGoogle Scholar
  30. 30.
    Sonnesyn SW, Gerding DN (1994) Antimicrobials for the treatment of respiratory infection. In: Niederman MS, Sarosi GA, Glassroth J (eds) Respiratory infections: a scientific basis for management. WB Saunders, Philadelphia, pp 511–537Google Scholar
  31. 31.
    Gantz N (1990) Patient compliance in the management of adult respiratory infections. Intern Med Specialist 1990(10):1–3Google Scholar
  32. 32.
    Gallup Organization (1995) Consumer attitudes toward antibiotic use. American Lung Association, New YorkGoogle Scholar
  33. 33.
    Destache CJ, Dewan N, O’Donahue WJ, Campbell JC, Angelillo VA (1999) Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 43(Suppl A):107–113PubMedCrossRefGoogle Scholar
  34. 34.
    Quenzer RW, Pettit KG, Arnold RJ, Kaniecki DJ (1997) Pharmacoeconomic analysis of selected antibiotics in lower respiratory tract infection. Am J Manag Care 3:1027–1036PubMedGoogle Scholar
  35. 35.
    Grossman R, Mukherjee M, Vaughan D, Eastwood C, Cook R, LaForge J, et al. (1998) A 1-year community-based health economic study of ciprofloxacin vs. usual antibiotic treatment in acute exacerbations of chronic bronchitis: The Canadian Ciprofloxacin Health Economic Study Group. Chest 113:131–141PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • M. S. Niederman
    • 1
    • 2
  1. 1.Pulmonary and Critical Care Division and Department of MedicineWinthrop-University HospitalMineolaUSA
  2. 2.Department of MedicineState University of New York at Stony BrookStony BrookUSA

Personalised recommendations