Treatments in Respiratory Medicine

, Volume 4, Issue 3, pp 153–167

Role of Antimicrobial Agents in the Management of Exacerbations of COPD

Current Opinion

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a common occurrence and characterize the natural history of the disease. Over the past decade, new knowledge has substantially enhanced our understanding of the pathogenesis, outcome and natural history of AECOPD. The exacerbations not only greatly reduce the quality of life of these patients, but also result in hospitalization, respiratory failure, and death. The exacerbations are the major cost drivers in consumption of healthcare resources by COPD patients. Although bacterial infections are the most common etiologic agents, the role of viruses in COPD exacerbations is being increasingly recognized. The efficacy of antimicrobial therapy in acute exacerbations has established a causative role for bacterial infections. Recent molecular typing of sputum isolates further supports the role of bacteria in AECOPD. Isolation of a new strain of Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae was associated with a considerable risk of an exacerbation. Lower airway bacterial colonization in stable patients with COPD instigates airway inflammation, which leads to a protracted self-perpetuating vicious circle of progressive lung damage and disease progression. A significant proportion of patients treated for COPD exacerbation demonstrate incomplete recovery, and frequent exacerbations contribute to decline in lung function. The predictors of poor outcome include advanced age, significant impairment of lung function, poor performance status, comorbid conditions and history of previous frequent exacerbations requiring antibacterials or systemic corticosteroids. These high-risk patients, who are likely to harbor organisms resistant to commonly used antimicrobials, should be identified and treated with antimicrobials with a low potential for failure. An aggressive management approach in complicated exacerbations may reduce costs by reducing healthcare utilization and hospitalization.

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References

  1. 1.
    Pauwels RA, Buist AS, Calverley PMA, et al. Global strategy for the diagnosis, management, and management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001; 163: 1256–76. Available from URL: http://www.goldcopd.com [Accessed 2005, Apr 30]PubMedGoogle Scholar
  2. 2.
    National Heart, Lung and Blood Institute. Morbidity & mortality: Chartbook on cardiovascular, lung and blood diseases. Bethesda (MD): US Department of Health and Human Services, Public Health Service, National Institute of Health, 1998Google Scholar
  3. 3.
    Statistical abstract of the United States, 2004. Washington Census Bureau 2004: 103: 24. Available from URL: http://www.census.gov/prod/www/statistical-abstract-04.html [Accessed 2005 Apr 30]
  4. 4.
    Murray CJL, Lopez AD. Evidence-based health policy lessons from the Global Burden of Disease Study. Science 1996; 274: 740–3PubMedCrossRefGoogle Scholar
  5. 5.
    The COPD Guidelines Group of the Standards of Care Committee of the BTS. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52 Suppl. 5: S1–S28Google Scholar
  6. 6.
    Connors Jr AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease [published erratum appears in Am J Respir Crit Care Med 1997; 155: 386]. Am J Respir Crit Care Med 1996; 154: 959–67PubMedGoogle Scholar
  7. 7.
    Voelkel NF, Tuder R. COPD Exacerbation. Chest 2000; 117: 376S–9SPubMedCrossRefGoogle Scholar
  8. 8.
    Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204PubMedGoogle Scholar
  9. 9.
    Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000; 117 Suppl. 2: 398S–401SPubMedCrossRefGoogle Scholar
  10. 10.
    McHardy VU, Inglis JM, Calder MA, et al. A study of infective and other factors in exacerbations of chronic bronchitis. Br J Dis Chest 1980; 74: 228–38PubMedCrossRefGoogle Scholar
  11. 11.
    Soler N, Torres A, Ewig S, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998; 157: 1498–505PubMedGoogle Scholar
  12. 12.
    Wedzidha JA. Exacerbations, etiology and pathophysiologic mechanics. Chest 2002; 121: 1365–415CrossRefGoogle Scholar
  13. 13.
    Sethi S, Murphy TF. Bacterial infection in chronic obstructive pulmonary disease in 200: a state-of-the-art review. Clin Microbiol Rev 2001; 14: 336–63PubMedCrossRefGoogle Scholar
  14. 14.
    Seemungal TAR, Wedzicha JA. Viral infections in obstructive airway diseases. Curr Opin Pulm Med 2003; 9: 111–6PubMedCrossRefGoogle Scholar
  15. 15.
    Smith CB, Golden C, Kenner R, et al. Association of viral and Mycoplasma pneumoniae infections with acute respiratory illness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1980; 121: 225–32PubMedGoogle Scholar
  16. 16.
    Fagon J-Y, Chastre J, Trouillet J-L, et al. Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis. Am Rev Respir Dis 1990; 142: 1004–8PubMedGoogle Scholar
  17. 17.
    Monso E, Ruiz J, Rosell A, et al. 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 1995; 152: 1316–20PubMedGoogle Scholar
  18. 18.
    Eller J, Ede A, Schaberg T, et al. Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function. Chest 1998 Jun; 113(6): 1542–8PubMedCrossRefGoogle Scholar
  19. 19.
    Hirschmann JV. Bacteria and COPD exacerbation redux. Chest 2001; 119: 663–7PubMedCrossRefGoogle Scholar
  20. 20.
    Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001 Nov 1; 164(9): 1618–23PubMedGoogle Scholar
  21. 21.
    Rhode G, Wiethege A, Borg I, et al. Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalization: a case control study. Thorax 2003; 58: 37–42CrossRefGoogle Scholar
  22. 22.
    Hirschmann JV. Do bacteria cause exacerbations of COPD? Chest 2000; 118: 193–203PubMedCrossRefGoogle Scholar
  23. 23.
    Tager I, Speizer FE. Role of infection in chronic bronchitis. N Engl J Med 1975; 292: 563–71PubMedCrossRefGoogle Scholar
  24. 24.
    Murphy TF, Sethi S. State of the art; bacterial infection in chronic obstructive lung disease. Am Rev Respir Dis 1992; 146: 1067–83PubMedGoogle Scholar
  25. 25.
    Patel IS, Seemungal TAR, Wilks M, et al. Relationship between bacterial colonization and the frequency, character, and severity of COPD exacerbations. Thorax 2002; 57: 759–64PubMedCrossRefGoogle Scholar
  26. 26.
    Reichek N, Lewin EB, Rhoden DL, et al. Antibody responses to bacterial antigens during exacerbations of chronic bronchitis. Am Rev Respir Dis 1970; 101: 238–44PubMedGoogle Scholar
  27. 27.
    Haase EM, Campagnari AA, Sarvar J, et al. Strain-specific and immunodominant surface epitopes of the P2 porin protein of non-typeable Haemophilus influenzae. Infect Immun 1991; 59: 1278–84PubMedGoogle Scholar
  28. 28.
    Medici TC, Chodosh S. The reticuloendothelial system in chronic bronchitis. Am Rev Respir Dis 1972; 105(5): 792–804PubMedGoogle Scholar
  29. 29.
    Hill AT, Campbell EJ, Hill SL, et al. Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis. Am J Med 2000; 109: 288–95PubMedCrossRefGoogle Scholar
  30. 30.
    Stockley RA. Role of bacteria in the pathogenesis and progression of acute and chronic lung infection. Thorax 1998; 53: 58–62PubMedCrossRefGoogle Scholar
  31. 31.
    Stockley RA, O’Brien C, Pye A, et al. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117: 1638–45PubMedCrossRefGoogle Scholar
  32. 32.
    Sethi S, Evans N, Grant BJB, et al. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002; 347: 465–71PubMedCrossRefGoogle Scholar
  33. 33.
    Sethi S. Infectious etiology of acute exacerbations of chronic bronchitis. Chest 2000; 117 Suppl. 2: 380S–5SPubMedCrossRefGoogle Scholar
  34. 34.
    Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations: a meta-analysis. JAMA 1995; 273: 957–60PubMedCrossRefGoogle Scholar
  35. 35.
    Nicotra MB, Rivera M, Awe RJ. Antibiotic therapy of acute exacerbations of chronic bronchitis. Ann Intern Med 1982; 97: 18–21PubMedGoogle Scholar
  36. 36.
    McCrory DC, Brown C, Gelfand SE, et al. Management of exacerbations of COPD: a summary and appraisal of the published evidence. Chest 2001; 119: 1190–209PubMedCrossRefGoogle Scholar
  37. 37.
    Miravitlles M, Espinosa C, Fernandez-Laso E, et al. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest 1999; 16: 40–6CrossRefGoogle Scholar
  38. 38.
    Wilkinson TMA, Patel IS, Wilks M, et al. Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003; 167: 1090–5PubMedCrossRefGoogle Scholar
  39. 39.
    Stockley RA, Bayley D, Hill SL, et al. Assessment of airway neutrophils by sputum colour: correlation with airways inflammation. Thorax 2001; 56: 366–72PubMedCrossRefGoogle Scholar
  40. 40.
    Wedzicha JA. Airway infection accelerates decline of lung function in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001 Nov; 164(10): 1757–8PubMedGoogle Scholar
  41. 41.
    Cole P, Wilson R. Host-microbial interrelationships in respiratory infection. Chest 1989; 95: 217S–21SCrossRefGoogle Scholar
  42. 42.
    Wilson R. Outcome predictors in bronchitis. Chest 1995; 108: 53S–7SPubMedCrossRefGoogle Scholar
  43. 43.
    Fletcher CM. Chronic bronchitis. Am Rev Respir Dis 1959; 80: 483–94PubMedGoogle Scholar
  44. 44.
    Howard P. A long-term follow-up of respiratory symptoms and ventilatory function in a group of working men. Br J Ind Med 1970; 27: 326–33PubMedGoogle Scholar
  45. 45.
    Bates DV. The fate of the chronic bronchitis: a report of the 10-year follow-up in the Canadian Department of Veterans Affairs coordinated study of chronic bronchitis. Am Rev Respir Dis 1973; 108: 1043–65PubMedGoogle Scholar
  46. 46.
    Anthonisen NR, Connett JE, Kiley J, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV 1. JAMA 1994; 272: 1497–505PubMedCrossRefGoogle Scholar
  47. 47.
    Kanner RE, Anthonisen NR, Connett JE, et al. Lower respiratory illnesses promote FEV1 decline in current smokers but not in ex-smokers with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164: 358–64PubMedGoogle Scholar
  48. 48.
    Seemungal TAR, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608–13PubMedGoogle Scholar
  49. 49.
    Spencer S, Jones PW, GLOBE Study Group. Time course of recovery of health status following an ineffective exacerbation of chronic bronchitis. Thorax 2003; 58: 589–93PubMedCrossRefGoogle Scholar
  50. 50.
    Asmundsson T, Kilburn KH. Survival of acute respiratory failure: a study of 239 episodes. Ann Intern Med 1969; 70: 471–89PubMedGoogle Scholar
  51. 51.
    Connors AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Respir Crit Care Med 1996; 154: 959–67PubMedGoogle Scholar
  52. 52.
    Ball P, Harris JM, Lowson D, et al. Acute infective exacerbations of chronic bronchitis. QJM 1995; 88: 61–8PubMedGoogle Scholar
  53. 53.
    Dewan NA, Rafique S, Kanwar B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest 2000 Mar; 117(3): 662–71PubMedCrossRefGoogle Scholar
  54. 54.
    Roberts CM, Lowe D, Bucknall CE, et al. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax 2002 Feb; 57(2): 137–41PubMedCrossRefGoogle Scholar
  55. 55.
    Strom K. Survival of patients with chronic obstructive pulmonary disease receiving long-term domiciliary oxygen therapy. Am Rev Respir Dis 1993; 147: 585–91PubMedGoogle Scholar
  56. 56.
    Derenne JP, Fleury B, Pariente R. Acute respiratory failure of chronic obstructive lung disease. Am Rev Respir Dis 1988; 138: 1006–33PubMedCrossRefGoogle Scholar
  57. 57.
    Jansson SA, Andersson F, Borg S, et al. Costs of COPD in Sweden according to disease severity. Chest 2002; 122: 1994–2002PubMedCrossRefGoogle Scholar
  58. 58.
    Hilleman DE, Dewan M, Malesker M, et al. Pharmacoeconomic evaluation of COPD. Chest 2000; 118: 1278–82PubMedCrossRefGoogle Scholar
  59. 59.
    Gibson PG, Wlodarczyk JH, Wilson AJ, et al. Severe exacerbations of chronic obstructive airways disease: health resource use in general practice and hospital. J Quai Clin Pract 1998; 18: 125–33Google Scholar
  60. 60.
    Miravitlles M, Murio C, Guerrero T, et al. Pharmacoeconomic evaluation of acute exacerbation of chronic bronchitis. Chest 2002; 121: 1449–55PubMedCrossRefGoogle Scholar
  61. 61.
    Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest 2000; Suppl. 117: 5S–9SPubMedCrossRefGoogle Scholar
  62. 62.
    Rutten-van Molken MPMH, Postma MJ, Joore MA, et al. Current and future medical costs of asthma and chronic obstructive pulmonary disease in the Netherlands. Respir Med 1999; 93: 779–87PubMedCrossRefGoogle Scholar
  63. 63.
    McGuire A, Irwin DE, Fenn P, et al. The excess of acute exacerbations of chronic bronchitis in patients aged 45 and older in England and Wales. Value Health 2001; 4: 370–5PubMedCrossRefGoogle Scholar
  64. 64.
    Pechevis M, Fagnani F, Brin S, et al. Infections respiratories récidivantes du sujet atteint de bronchite chronique obstructive: prise en charge médicale et coüts (Recurrent respiratory infections in patients with chronic obstructive bronchitis: medical management and costs). Rev Mal Respir 1996; 13: 507–12PubMedGoogle Scholar
  65. 65.
    Anderson F, Borg S, Jansson SA, et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002; 96(9): 700–8CrossRefGoogle Scholar
  66. 66.
    Destache CJ, Dewan NA, O’Donohue WJ, et al. Clinical and economic considerations in acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 43 Suppl. A: 107–13PubMedCrossRefGoogle Scholar
  67. 67.
    Torrance G, Walker V, Grossman R, et al. Economic evaluation of ciprofloxacin compared with usual antibacterial care for the treatment of acute exacerbations of chronic bronchitis in patients followed for 1 year. Pharmacoeconomics 1999; 16: 499–520PubMedCrossRefGoogle Scholar
  68. 68.
    Quenzer RW, Pettit KG, Arnold RJ, et al. Pharmacoeconomic analysis of selected antibiotics in lower respiratory tract infection. Am J Manag Care 1997; 3: 1027–36PubMedGoogle Scholar
  69. 69.
    Backhouse R, Shakespeare A, Hutton J. Economic evaluation of alternative antibiotic regimens in the management of acute exacerbations of chronic bronchitis. Br J Med Econ 1995; 8: 11–25Google Scholar
  70. 70.
    Saint S, Flaherty KR, Abrahamse P, et al. Acute exacerbation of chronic bronchitis: disease-specific issues that influence the cost-effectiveness of antimicrobial therapy. Clin Ther 2001 Mar; 23(3): 499–512PubMedCrossRefGoogle Scholar
  71. 71.
    Van Barlingen H, Nuijten M, Volmer T, et al. Model to evaluate the cost-effectiveness of different antibiotics in the management of acute bacterial exacerbations of chronic bronchitis in Germany. J Med Econ 1998; 1: 201–18CrossRefGoogle Scholar
  72. 72.
    Anzueto A, Rizzo JA, Grossman RF. The infection free interval: its use in evaluating antimicrobial treatment of acute exacerbations of chronic bronchitis. Clin Infect Dis 1999; Suppl. 91: 87S-92SGoogle Scholar
  73. 73.
    Wool C, Cerutti R, Garbagna N, et al. A cost-effectiveness study of four different antibiotics in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Br J Med Econ 1996; 10: 159–68Google Scholar
  74. 74.
    MacFarlane JT, Colville A, Guion A, et al. Prospective study of etiology and outcome of adult lower respiratory tract infections in the community. Lancet 1993; 341: 511–4PubMedCrossRefGoogle Scholar
  75. 75.
    Lode H. Respiratory tract infections: when is antibiotic therapy indicated? Clin Ther 1991; 13: 149–56PubMedGoogle Scholar
  76. 76.
    Kessler R, Faller M, Fourgaut G, et al. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 158–64PubMedGoogle Scholar
  77. 77.
    Miravitlles M, Guerrero T, Mayordomo C, et al. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. The EOLO Study Group. Respiration 2000; 67: 495–501Google Scholar
  78. 78.
    Miravitlles M, Murio C, Guerrero T, et al. Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. Eur Respir J 2001; 17: 928–33PubMedCrossRefGoogle Scholar
  79. 79.
    Balter MS, Hyland RH, Low DE, et al. Recommendations on the management of chronic bronchitis. CMAJ 1994; 151 Suppl. 10: 5–23Google Scholar
  80. 80.
    Balter MS, Forge JL, Low DE, et al. Canadian guideline for the management of acute exacerbation of chronic bronchitis: executive summary. Can Respir J 2003; 10: 248–63PubMedGoogle Scholar
  81. 81.
    Grossman RF. Guidelines for the treatment of acute exacerbation of chronic bronchitis. Chest 1997; Suppl. 112: 310S-3SGoogle Scholar
  82. 82.
    Sharma S, Anthonisen N. Antibiotics. In: Barnes P, Drazen J, Rennard S, et al. editors. Asthma and COPD: basic mechanisms and clinical management. London; Academic Press 2002: 573–86Google Scholar
  83. 83.
    Sharma S, Anthonisen N. Antibiotics in AECOPD: acute exacerbation of chronic obstructive pulmonary disease. In: Siafakas N, New York (NY): Marcel Dekker Inc., editor. Lung Biol in Health Dis 2003; 183: 331–4Google Scholar
  84. 84.
    Adams SG, Jairo Melo J, Michael LM. Antibiotics are associated with lower relapse rate in outpatients with acute exacerbations iof COPD. Chest 2000; 117: 1345–52PubMedCrossRefGoogle Scholar
  85. 85.
    Doern GV, Brueggemann AB, Pierce G, et al. 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 1997 Feb; 41(2): 292–7PubMedGoogle Scholar
  86. 86.
    Doern GV, Brueggemann AB, Huynh H, et al. Antimicrobial resistance with Streptococcus pneumoniae in the United States, 1997-8. Emerg Infect Dis 1999; 5: 757–65PubMedCrossRefGoogle Scholar
  87. 87.
    Doern GV, Pfaller MA, Kugler K, et al. Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from SENTRY antimicrobial surveillance program. Clin Infect Dis 1999; 27: 764–70CrossRefGoogle Scholar
  88. 88.
    Doern GV, Heilmann KP, Huynh HK, et al. Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during 1999–2000, including a comparison of resistance rates since 1994–1995. Antimicrob Agents Chemother 2001; 45: 1721–9PubMedCrossRefGoogle Scholar
  89. 89.
    Gordon KA, Biedenbach DJ, Jones RN. Comparison of Streptococcus pneumoniae and Haemophilus influenzae susceptibilities from community-acquired respiratory tract infections and hospitalized patients with pneumonia: five-year results for the SENTRY antimicrobial surveillance program. Diagn Microbiol Infect Dis 2003 Aug; 46(4): 285–9PubMedCrossRefGoogle Scholar
  90. 90.
    Jones ME, Blosser-Middleton RS, Critchley IA, et al. In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis: a European multicenter study during 2000–2001. Clin Microbiol Infect 2003 Jul; 9(7): 590–9PubMedCrossRefGoogle Scholar
  91. 91.
    Schito AM, Schito GC, Debbia E, et al. Antibacterial resistance in Streptococcus pneumoniae and Haemophilus influenzae from Italy and Spain: data from the PROTEKT surveillance study, 1999–2000. J Chemother 2003 Jun; 15(3): 226–34PubMedGoogle Scholar
  92. 92.
    Archibald L, Phillips L, Monnet D, et al. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997 Feb; 24(2): 211–5PubMedCrossRefGoogle Scholar
  93. 93.
    Wilson R, Kubin R, Ballin I, et al. Five day moxifloxacin therapy compared with 7 day clarithromycin therapy for the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 44: 501–13PubMedCrossRefGoogle Scholar
  94. 94.
    Gotfried MH, DeAbate CA, Fogarty C, et al. Comparison of 5-day, short-course gatifloxacin therapy with 7-day gatifloxacin therapy and 10-day clarithromycin therapy for acute exacerbation of chronic bronchitis. Clin Ther 2001; 23: 97–107PubMedCrossRefGoogle Scholar
  95. 95.
    DeAbate CA, Mathew CP, Warner JH, Heyd A, Church D. The safety and efficacy of short course moxifloxacin vs azithromycin in the treatment of patients with acute exacerbations of chronic bronchitis. Respir Med 2000: 94; 1029–37PubMedCrossRefGoogle Scholar
  96. 96.
    Grossman R, Mukharjee J, Vaughan D, et al. A one 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 1998; 113: 131–41PubMedCrossRefGoogle Scholar
  97. 97.
    Madaras-Kelly KJ, Magdanz SB, Johnson CK, et al. Clinical outcomes of ambulatory acute exacerbations of chronic bronchitis with older versus newer antimicrobials. Ann Pharmacother 2002 Jun; 36: 975–80PubMedCrossRefGoogle Scholar
  98. 98.
    Anzueto A. Treatment of acute exacerbations of chronic bronchitis: antibiotic therapy. Sem Resp Crit Care Med 2000; 21: 97–106CrossRefGoogle Scholar
  99. 99.
    Thornsberry C, Ogilvie, Kahn J, et al. Surveillance of antimicrobial resistance in S pneumonia, H influenzae and M Catarrhalis in the United States in 1996–1997. Diagn Microbiol Infect Dis 1997: 29, 249–57PubMedCrossRefGoogle Scholar
  100. 100.
    Maesen FPV, Geraedts WH, Davies BI. Cefaclor in the treatment of chronic bronchitis. J Antimicrob Chemother 1990; 26: 456–8PubMedCrossRefGoogle Scholar
  101. 101.
    Verghese A. Efficacy of cefixime in respiratory tract infections. Adv Ther 1990; 7: 9–15Google Scholar
  102. 102.
    White AR, Kaye C, Poupard J et al. Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. J Antimicrob Chemother 2004; 53: Suppl. 1, 3–20CrossRefGoogle Scholar
  103. 103.
    Todd PA, Benfield P. Amoxicillin/clavulanic: an update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 1990; 39: 264–307PubMedCrossRefGoogle Scholar
  104. 104.
    Mehta S, Parr JH, Morgan DJR. A comparison of cefuroxime and co-trimoxazole in severe respiratory tract infections. J Antimicrob Chemother 1982; 9: 479–84CrossRefGoogle Scholar
  105. 105.
    Huovinen P. Resistance to trimethoprim-sulfamethoxazole. Infect Dis 2001 Jun 1; 32(11): 1608–14CrossRefGoogle Scholar
  106. 106.
    Clavo-Sanchez AJ, Giron-Gonzalez JA, Lopez-Prieto D, et al. Multivariate analysis of risk factors for infection due to penicillin resistant and multidrug resistant Streptococcus pneumonia: a multicentre study. Clin Infect Dis 1997; 24: 1052–9PubMedCrossRefGoogle Scholar
  107. 107.
    Zhanel GG, Dueck M, Hoban DJ, et al. Review of macrolides and ketolides: fcus on respiratory tract infections. Drugs 2001; 61: 443–98PubMedCrossRefGoogle Scholar
  108. 108.
    Hoepelma IM, Mollers MJ, vanSchie MH, et al. A short (3 day) course of azithromycin tablet versus a 10-day course of amoxicillin-clavulanic acid in the treatment of adults with lower respiratory tract infections and effects on long term outcome. Int J Antimicrob Agents 1997; 9: 141–6CrossRefGoogle Scholar
  109. 109.
    Alvarez-Elcoro S, Eichel B, Ellis C, et al. Erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc 1999; 74: 613–34PubMedCrossRefGoogle Scholar
  110. 110.
    Amsden GW, Baird IM, Simon S, et al. Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Chest 2003; 123: 772–7PubMedCrossRefGoogle Scholar
  111. 111.
    Castaldo RS, Celli BR, Gomez F, et al. A comparison of 5-day courses of dirithromycin and azithromycin in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Clin Ther 2003; 25: 542–57PubMedCrossRefGoogle Scholar
  112. 112.
    Weiss K, Vanjaka A, Canadian Clarithromycin Study Group on Bronchitis. An open-label, randomized, multicentre, comparative study of the efficacy and safety of 7 days of treatment with clarithromycin extended release tablets versus clarithromycin immediate-release tablets for the treatment of patients with acute bacterial exacerbation of chronic bronchitis. Clin Ther 2002; 24: 2105–22PubMedCrossRefGoogle Scholar
  113. 113.
    Bachand RT. A comparative study of clarithromycin and ampicillin in the treatment of patients with acute bacterial exacerbation of chronic bronchitis. J Antimicrob Chemother 1991; 27 Suppl. A: 91–100PubMedGoogle Scholar
  114. 114.
    Anzueto A, Fisher Jr CL, Busman T, et al. Comparison of the efficacy of extended-release clarithromycin tablets and amoxicillin/clavulanate tablets in the treatment of acute exacerbation of chronic bronchitis. Clin Ther 2001 Jan; 23(1): 72–86PubMedCrossRefGoogle Scholar
  115. 115.
    Martinot JB, Carr WD, Cullen S, et al. Clarithromycin Once-a-Day Study Group. A comparative study of clarithromycin modified release and amoxicillin/clavulanic acid in the treatment of acute exacerbation of chronic bronchitis. Adv Ther 2001; 18: 1–11Google Scholar
  116. 116.
    Blondeau JM. A review of the comparative in vitro activities of 12 antimicrobial agents, with a focus on five new “respiratory quinolones”. J Antimicrob Chemother 1999; 43 Suppl. B: 1–11PubMedCrossRefGoogle Scholar
  117. 117.
    Lode H, Allewelt M. Role of newer fluoroquinolones in lower respiratory tract infections. J Antimicrob Chemother 2002 Jul; 50(1): 151–4PubMedCrossRefGoogle Scholar
  118. 118.
    Bishai W. Current issues on resistance, treatment guidelines, and the appropriate use of fluoroquinolones for respiratory tract infections. Clin Ther 2002 Jun; 24(6): 838–50PubMedCrossRefGoogle Scholar
  119. 119.
    Anzueto A, Niederman MS, Tillotson GS. Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: ciprofloxacin 750mg b.i.d. versus clarithromycin 500mg b.i.d. Bronchitis Study Group. Clin Ther 1998 Sep–Oct; 20(5): 885–900Google Scholar
  120. 120.
    Shah PM, Maesen FP, Dolmann A, et al. Levofloxacin versus cefuroxime axetil in the treatment of acute exacerbation of chronic bronchitis: results of a randomized, double-blind study. J Antimicrob Chemother 1999; 43: 529–39PubMedCrossRefGoogle Scholar
  121. 121.
    Masterton RG, Burley CJ. Randomized, double-blind study comparing 5- and 7-day regimens of oral levofloxacin in patients with acute exacerbations of chronic bronchitis. Int J Antimicrob Agents 2001; 18: 503–12PubMedCrossRefGoogle Scholar
  122. 122.
    Gotfried MH, DeAbate CA, Fogarty C, et al. Comparison of 5-day, short cause gatifloxacin therapy with 7-day gatifloxacin therapy and 10-day clarithromycin therapy for acute exacerbation of chronic bronchitis. Clin Ther 2001; 23: 97–107PubMedCrossRefGoogle Scholar
  123. 123.
    Anzueto A, Gotfried M, Wilder MA, et al. Efficacy and tolerability of gatifloxacin in community treatment of acute exacerbations of chronic bronchitis. Clin Ther 2002, 17Google Scholar
  124. 124.
    Chodosh S, DeAbate CA, Haverstock D, et al. Short course of moxifloxacin therapy for treatment of acute exacerbation of chronic bronchitis. Respir Med 2000; 94: 18–27PubMedCrossRefGoogle Scholar
  125. 125.
    Schaberg T, Ballin I, Huchon G, et al. A Multinational, multicentre, non-blinded, randomized study of moxifloxacin oral tablets compared with co-amoxiclav oral tablets in the treatment of acute exacerbation of chronic bronchitis. J Int Med Res 2001; 29: 314–28PubMedGoogle Scholar
  126. 126.
    Grassi C, Casali L, Curti E, et al. Studio Multicentrico con Moxifloxacina nel Trattamento delle Riacutizzazioni de Bronchite Cronica. Efficacy and safety of short course (5-day) moxifloxacin vs 7-day ceftriaxone in the treatment of acute exacerbations of chronic bronchitis (AECB). J Chemother 2002; 14: 597–608PubMedGoogle Scholar
  127. 127.
    Wilson R, Allegra L, Huchon G et al. Short-term and long-term outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 2004; 125: 953–64PubMedCrossRefGoogle Scholar
  128. 128.
    Wilson R, Schentag JJ, Ball P, et al. A comparison of gemifloxacin and clarithromycin in acute exacerbations of chronic bronchitis and long-term clinical outcomes. Clin Ther 2002; 24: 639–52PubMedCrossRefGoogle Scholar
  129. 129.
    Spencer S, Jones PW. Time course of recovery of health status following an infective exacerbation of chronic bronchitis. Thorax 2003; 58(7): 589–93PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Section of Respirology, Department of Internal MedicineUniversity of Manitoba, BG034, St Boniface General HospitalWinnipegCanada

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