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

Expert Commentary

Overuse of antibiotics has led to increasing antimicrobial resistance. Thus, the selection of appropriate antibiotics for empirical therapy of AECB is complicated by the changing resistance patterns of causative pathogens. Fluoroquinolones have excellent activity against most AECB-causing Gram-negative pathogens, and superior activity against Gram-positive, atypical and anaerobic respiratory pathogens compared with commonly prescribed antimicrobials. Their clinical efficacy and tolerability profile are equivalent to those of commonly prescribed antibiotics, and quinolone resistance among community-acquired respiratory pathogens is minimal.

Many of the studies described in this paper were designed to show equivalence between agents and may not have been powered to show clinical superiority of one antimicrobial over another. Moreover, differences between patient groups could be confounded by factors related to disease severity or etiology. Future studies designed to include separate subgroup analyses according to risk factors for poor outcomes or comorbidities, as well as head-to-head studies comparing the different fluoroquinolones, will ensure targeted and specific therapy, and may simplify the challenging issue of antimicrobial choice.

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