Acute exacerbation of chronic bronchitis

Sethi S, Murphy TF. Acute exacerbations of chronic bronchitis new developments concerning microbiology and pathophysiology— impact on approaches to risk stratification and therapy. Infect Dis Clin North Am 2004 18 861-882. 

An increased number of polymorphonuclear granulocytes in sputum often suggests continual bronchial irritation, whereas an increased number of eosinophils may suggest an allergic component. The most common bacterial isolates (expressed in percentages of total cultures) identified from sputum culture in patients experiencing an acute exacerbation of chronic bronchitis are as follows ... 

Safety and efficacy of drug administered less than 10 days in patients with acute exacerbations of chronic bronchitis have not been established. 

Acute exacerbations of chronic bronchitis in adults - Acute exacerbations of chronic bronchitis in adults caused by susceptible strains of/-/, influenzae and S. pneumoniae. 

Un, acute exacerbation of chronic bronchitis prophylaxis in transurethral procedures Action Quinolone antibiotic -1- DNA gyrase. Dose 400 mg/d PO X w/ renal insuff, avoid antacids Caution [C, —] Interactions w/ cation-containing products Contra Quinolone all gy, children <18 y,T QT interval, X Disp Tabs SE NA/ /D, abd pain, photosens, Szs, HA, dizziness, tendon rupture, periph al neuropathy, pseudomembranous cohtis, anaphylaxis Interactions t Effects W/ cimetidine, probenecid T effects OF cyclosporine, warfarin, caffeine X effects W/ antacids EMS Monitor ECG for TqT int val, esp in pts taking class lA/III antiarrhythmics monitor ECG and BP for signs of h5 povolemia and electrol5rte disturbances (hypokalemia) d/t D T risk of photosensitivity Rxns OD May cause NA /D, confusion and Szs symptomatic and supportive... 

Acute exacerbation of chronic Bronchitis PO 300 mg ql2h for 5-10 days. 

Acute exacerbation of chronic bronchitis PO 400 mg twice a day for 10 days. Community-acquired pneumonia PO 400 mg 2 twice a day for 14 days. 

Otitis media, acute bronchitis, acute exacerbations of chronic bronchitis, pharyngitis, tonsillitis, and uncomplicated UTIs PO 400 mg/day as a single dose or in 2 divided doses. 

Lower respiratory tract infections e.g., pneumonia, acute bronchitis and acute exacerbations of chronic bronchitis. 

Pneumonia, acute bronchitis and acute exacerbation of chronic bronchitis. 

Indications IV Infusion Prophylaxis and treatment of Pneumocystis car/n/ pneumonia Shigellosis Severe or complicated urinary tract infections Tablets Prophylaxis and treatment of Pneumocystis carinii pneumonia Acute exacerbation of chronic bronchitis Urinary tract infections Travelers diarrhea in adults Shigellosis Acute otitis media ... 

Generation] Uses Acute exacerbations of chronic bronchitis, pharyngitis, tonsillitis skin Infxns Action 3rd-gen cephalosporin X cell wall synth Dose Adults Peds >12 y Skin 200 mg PO bid x 10 d Chronic bronchitis, pharyngitis, tonsillitis 400 mg PO bid x 10 d avoid antacids w/in 2 h take w/ meals X in renal impair Caution [B, ] Renal/hepatic impair Contra Cephalosporin/PCN allergy, milk protein, or carnitine deficiency Disp Tabs SE HA, N/V/D, colitis, nephrotox,... 

Oral bioavailability is 57%, and tissue and intracallular penetration is generally good. Telithromycin is metabolized in the liver and eliminated by a combination of biliary and urinary routes of excretion. It is administered as a once-daily dose of 800 mg, which results in peak serum concentrations of approximately 2 g/mL. Telithromycin is indicated for treatment of respiratory tract infections, including community-acquired bacterial pneumonia, acute exacerbations of chronic bronchitis, sinusitis, and streptococcal pharyngitis. Telithromycin is a reversible inhibitor of the CYP3A4 enzyme system. 

Community-acquired pneumonia, acute exacerbation of chronic bronchitis, other lower gonococcal and nongonococcal burethritis in complicated UTI Immunomodulator Anti-HIV... 

Ball P, Make B. Acute exacerbations of chronic bronchitis an international comparison. Chest, 1998, 113 (3 Suppl.), 199S-204S. 

Wilson R, et al. Short-term and longterm outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis. Chest, 2004, 125, 953—964. 

Qll Acute exacerbations of chronic bronchitis can be caused either by viral or bacterial infections. Production of thick, green sputum suggests Chandra has a bacterial infection. Common bacterial pathogens affecting the lung include Streptococcus pneumoniae and Haemophilus influenzae. It is recommended that COPD patients receive influenza vaccine each year pneumoccocal vaccine is also often recommended in chronic lung disease and may prevent recurrence of chest infection in the elderly. 

Moxifloxacin Avelox Acute exacerbations of chronic bronchitis, community-acquired pneumonia, acute sinusitis, skin infections... 

Newer fourth-generation fluoroquinolones such as gati-floxacin, gemifloxacin, and moxifloxacin have improved activity against pneumococci, including macrolide- and penicillin-resistant strains, and are often termed the respiratory quinolones. They are indicated for acute exacerbations of chronic bronchitis, community-acquired pneumonia, and sinusitis. 

In a multicenter, double-blind, randomized comparison of trovafloxacin 200 mg and clarithromycin 500 mg bd in 176 subjects with acute exacerbations of chronic bronchitis, the most common adverse effects of trovafloxacin were nausea (5%), dizziness (5%), vomiting (3%), and constipation (3%) (1). Because trovafloxacin is hepato-toxic, the list of appropriate indications has been limited to patients who have at least one of several specified infections, such as nosocomial pneumonia or complicated intra-abdominal infections that are serious and life- or limb-threatening in the physician s judgement. 

In a randomized, double-blind comparison of pmUfloxa-cin 600 mg/day and ciprofloxacin 500 mg bd in 235 patients with acute exacerbations of chronic bronchitis, the most common treatment-related adverse event was gastric pain of mild or moderate intensity, reported in 8.5% of the patients taking prulifloxacin and 6.8% of those taking ciprofloxacin (30). 

In a multicenter, double-blind, randomized comparison of trovafloxacin 200 mg and clarithromycin 500 mg bd in 176 subjects with acute exacerbations of chronic bronchitis, the most common adverse effects of clarithromycin were nausea (3%), diarrhea (4%), and taste disturbances (4%) (9). 

McCarty JM, Pierce PF. Five days of cefprozil versus 10 days of clarithromycin in the treatment of an acute exacerbation of chronic bronchitis. Ann Allergy Asthma Immunol 2001 87(4) 327-34. 

In phase II trials oral gemifloxacin 320 mg/day produced bacteriological responses in 94% of patients with acute exacerbations of chronic bronchitis (6-8) and in 95% of patients with uncomplicated urinary tract infections. Adverse events included nausea, abdominal pain, headache, and a mild rash in both patients and healthy volunteers. 

In a randomized, donble-blind, mnlticenter comparison of a 5-day course of gemifloxacin 320 mg/day with a standard 7-day regimen of clarithromycin 500 mg bd in 712 patients with acute exacerbations of chronic bronchitis, the most frequently reported gemifloxacin-related adverse events were diarrhea (5.1%) and nausea (4.3%) (13). 

File T, Schlemmer B, Garau J, Lode H, Lynch S, Young C. Gemifloxacin versus amoxiciUin/clavulanate in the treatment of acute exacerbations of chronic bronchitis. The 070 Clinical Study group. J Chemother 2000 12(4) 314-25. 

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