Short-course Fluoroquinolones in Acute Exacerbations of Chronic Bronchitis

Mark H Gotfried; Ronald F Grossman

Disclosures

Expert Rev Resp Med. 2010;4(5):661-672. 

In This Article

Abstract and Introduction

Abstract

It is estimated that 50–70% of acute exacerbations of chronic bronchitis (AECB) are caused by bacterial infections. Appropriate selection of antimicrobials may lead to better outcomes and reduced healthcare costs. Respiratory fluoroquinolones (moxifloxacin, levofloxacin and gemifloxacin) have a broad spectrum of activity against most AECB-causing pathogens and are used as first-line treatment in patients with comorbidity, severe airway obstruction or recurrent exacerbations. We review studies, identified through a MEDLINE search, that compared clinical efficacy and speed of recovery for short-course (≤5 days) fluoroquinolone therapy with commonly prescribed standard therapy (≥7 days). Among 177 studies reporting the use of fluoroquinolones for AECB treatment, 23 used a short-course regimen, shown to be at least as effective as standard therapy of 7 or more days duration. Furthermore, evidence suggests that short-course therapy offers faster resolution of symptoms, faster rate of recovery, fewer relapses, fewer and shorter hospitalizations, and longer time between recurrences.

Introduction

An acute exacerbation of chronic bronchitis (AECB) is characterized by increased sputum volume, increased sputum purulence, worsening dyspnea, cough and increased sputum tenacity.[1,101] The first three of these symptoms, the cardinal symptoms, can be used to classify the exacerbation.[101] AECB can have a substantial economic impact on patients, the healthcare system and society.[2,3] Approximately 13 million individuals in the USA (4–6% of the adult population) have chronic bronchitis[2,4] and experience an average of two to three acute exacerbation episodes per year.[5] In the USA, more than 90% of patients with chronic bronchitis have sought treatment for their acute episodes, resulting in total healthcare costs of approximately US$1.6 billion.[6]

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