Infection and Antibiotic Treatment in Acute Exacerbations of Chronic Bronchitis

Abstract

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].