Treatment of acute exacerbations of chronic bronchitis: Antibiotic therapy

Acute exacerbation of chronic bronchitis (AECB) is a condition associated w ith increased morbidity and mortality. Bacterial infections are the most fr equent cause of exacerbations. The most common bacterial etiologies include Haemophilus influenzae, Moraxella catarrhalis, and Streptococeus pneumonia . The diagnosis of AE:CB is often based on the clinical presentation, but m icrobiological assessment, including Gram stain and sputum culture should b e done. Antibiotic therapy should be used in patients with the following ch aracteristics: underlying lung disease, frequent exacerbations, and comorbi d conditions. Penicillins, erythromycin, beta-lactamase inhibitors, and tri methoprim-sulfamethoxazole have been the preferred antibiotics. However, be cause of the increasing prevalence of resistance among respiratory pathogen s, mainly the production of beta-lactamase by H. influenzae and IM. catarrh alis, and the emergence of multidrug-resistant S. pneumonia, new generation macrolides and fluoroquinolones should be the first line of treatment in s elected patients. These drugs have increased efficacy and safety.