Optimizing economic outcomes in antibiotic therapy of patients with acute bacterial exacerbations of chronic bronchitis

The social, medical and economic effects of acute bacterial exacerbations o f chronic bronchitis on individual patients and the resource implications o f this disease for the healthcare sector are considerable. Optimizing the s election of patients who should receive antibiotics according to stringent clinical criteria is the first step in promoting good clinical practice and cost-effectiveness. Antibiotic efficacy is then the major driver of cost, especially when it reduces the need for hospitalization. Resistance to firs t-line antibiotics can be expected to increase the risk of treatment failur e. Other drivers of cost include non-compliance, which predisposes to thera peutic failure, and the selection of resistant strains. Treatment regimens of short duration, once-daily dosing and good tolerability are determinants of good compliance and cost savings. The expenses of first-line antibiotic s typically account for only a small proportion of the overall costs of hea lthcare and the cheapest antibiotics are not necessarily the most cost-effe ctive. The clinical success rate of first-line therapy is the primary deter minant of the overall expenditure on healthcare because of the high costs a ssociated with treatment failure, especially if it leads to hospitalization . Factors such as poor patient compliance and high antibiotic resistance ra tes, which undermine the clinical efficacies of first-line therapy, will in crease the overall costs of treatment.