Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis

Limited data exist to guide physicians in the cost-effective treatment of a cute exacerbation of chronic bronchitis (AECB). Therefore, the main objecti ve of this study was to determine the antimicrobial efficacy and related co sts for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) a nd chronic bronchitis episodes from a pulmonary clinic of a teaching instit ution was undertaken. The participating patients had a total of 224 episode s of AECB requiring antibiotic treatment. Before review, empirical antibiot ic choices were divided into first-line (amoxycillin, co-trimoxazole, tetra cyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cef prozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently t han third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescri bed first-line agents were hospitalized significantly more often for AECB w ithin 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-li ne agents (P < 0.005). Pharmacy costs were lowest with first-line agents (f irst-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$ 45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; secon d-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-lin e antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantl y reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.