Short-course Fluoroquinolones in Acute Exacerbations of Chronic Bronchitis

Mark H Gotfried; Ronald F Grossman


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

In This Article

Antimicrobial Therapy for AECB

Successful management of AECB involves appropriate selection and use of antibiotic agents and adjunctive treatments, including removal of irritants; hydration; utilization of oxygen, corticosteroids and bronchodilators; and chest physical therapy.[3,5,15] Antimicrobial therapy can be effective in the treatment of AECB, leading to improvement in peak expiratory flow rates, fewer hospitalizations, lower relapse rates and a higher percentage of clinical successes.[1,16–18]

Current guidelines for antimicrobial therapy in patients with AECB have been established by the Global Initiative for Chronic Obstructive Lung Disease (GOLD),[101] the American Thoracic Society,[102] the Canadian Thoracic Society, the Canadian Infectious Disease Society,[3,19] the European Respiratory Society[20] and a consensus statement formulated by Spanish medical societies.[21]

A series of broad-spectrum antibacterial agents, such as amoxicillin, trimethoprim–sulfamethoxazole and doxycycline, have been traditionally used as first-line treatment options for patients with mild AECB and no additional risk factors.[3,10] Alternative antibacterials, including β-lactams/β-lactamase inhibitors, cephalosporins and macrolides, have been recommended in treatment guidelines as first-line treatment options for patients with mild-to-moderate AECB.[10]

The respiratory fluoroquinolones include levofloxacin, moxifloxacin and gemifloxacin and have been recommended as a first-line treatment for AECB in patients who have chronic bronchitis complicated by comorbid illness, severe obstruction with forced expiratory volume in 1 s (FEV1) less than 50%, old age (>65 years) or those who have recurrent exacerbations.[3,4,10]


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