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

Five-year View

It is anticipated that overprescribing of antimicrobial therapy will continue to remain a problem over the next 5 years, despite continued efforts to promote appropriate prescribing. This in turn will continue to fuel the selection of bacterial resistance, and thus resistance will become an even greater problem among the 'workhorse' antibiotics used to treat the most common pathogens. The lack of new antimicrobials under development will further increase the need to use those agents with the greatest effectiveness, thereby increasing the need for more thoughtful and careful use of these agents. Along with considerations of the appropriate selection of agents, clinicians will be faced with important decisions about appropriate dosing and duration of therapy.

The new healthcare bill just passed by the US government will bring an estimated 32 million newly insured patients to offices of primary care physicians, who are responsible for over 70% of all antibiotic prescribing. This will add further pressure to the need for appropriate antibiotic prescribing. Thus, there is a need for ongoing educational efforts focused on the rationale for appropriate prescribing and for guidelines that can be effectively implemented in the community and institutional settings.

The new healthcare bill will also require the implementation of cost–effectiveness research to support and justify reimbursement for various treatment strategies. While the initial focus of this research will probably not be on antimicrobial therapy, it is possible that this broader view of appropriate treatment selection could lead to a greater awareness and focus on the overall impact and cost of care for an individual. Should that occur, consideration of the overall outcomes of treating infectious diseases, including adverse events and development of resistant organisms, could well become an area of payer scrutiny.

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