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Niederman MS, Anzueto A, Sethi S, Choudhri S, Kureishi A, Haverstock D, Perroncel R. Eradication of H. influenzae in AECB: A pooled analysis of moxifloxacin phase III trials compared with macrolide agents. Respir Med 2006; 100:1781-90. [PMID: 16531032 DOI: 10.1016/j.rmed.2006.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 01/10/2006] [Accepted: 01/29/2006] [Indexed: 10/24/2022]
Abstract
Haemophilus influenzae is the most common bacterial pathogen associated with acute exacerbations of chronic bronchitis (AECB). This study determined the rate of bacterial eradication of H. influenzae during AECB treated with either macrolides or moxifloxacin. Adult AECB patients with H. influenzae were included in a pooled analysis of four double-blind, multicentre, randomised trials. Patients received either moxifloxacin (400 mg qd for 5-10 days) or macrolides (azithromycin 500 mg/250 mg qd for 5 days or clarithromycin 500 mg bid for 5-10 days). Bacterial eradication and clinical success were recorded at the test-of-cure visit (7-37 days post-therapy). Of 2555 patients in the intent-to-treat population, 910 were microbiologically valid and 292 (32%) had H. influenzae cultured at baseline. Bacterial eradication of H. influenzae was significantly higher with moxifloxacin vs. macrolide-treated patients (93.0% [133/143] vs. 73.2% [109/149], respectively, P = 0.001). Moxifloxacin also demonstrated higher eradication rates compared with azithromycin (96.8% vs. 84.6%, P = 0.019) and clarithromycin (90.1% vs. 64.2%, P = 0.001) analysed separately. Clinical success was 89.5% (128/143) for moxifloxacin vs. 85.2% (127/149) for the macrolide group (P = 0.278); similar results were found when moxifloxacin was compared individually with each macrolide. For patients with AECB due to H. influenzae, moxifloxacin provided superior bacterial eradication rates than macrolide therapy.
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Affiliation(s)
- M S Niederman
- Department of Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 509, Mineola, NY 11501, USA.
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202
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Soler N, Agustí C, Angrill J, Puig De la Bellacasa J, Torres A. Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease. Thorax 2006; 62:29-35. [PMID: 16928715 PMCID: PMC2111274 DOI: 10.1136/thx.2005.056374] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Antibiotics are commonly prescribed in exacerbations of chronic obstructive pulmonary disease (COPD). However, the role of bacteria in these exacerbations is controversial. OBJECTIVE To identify clinical predictors of bacterial infection as a cause of exacerbation, considering the protected specimen brush (PSB) as the gold standard. METHODS Clinical data, sputum and PSB samples were collected from 40 patients with COPD requiring hospitalisation due to severe exacerbations who had not received previous antibiotic treatment. RESULTS Quantitative cultures of PSB samples (n = 40) yielded 23 potential pathogenic microorganisms (PPMs) at concentrations of > or =10(2) colony-forming units/ml in 18 (45%) patients. Sputum samples were obtained from all 40 patients. Culture of good-quality sputum samples (n = 18) yielded 16 PPMs corresponding to 14 (35%) patients. The concordance between the PSB and sputum rate was high (kappa = 0.85, p < 0.002). The self-reporting patient observation of sputum purulence (odds ratio (OR) 27.20 (95% confidence interval (CI) 4.60 to 60.69), p = 0.001), the percentage predicted forced expiratory volume in 1 s (FEV(1)%) <50 (OR 2.27 (95% CI 1.55 to 3.21), p = 0.014), >4 exacerbations in the past year (OR 6.9 (95% CI 0.08 to 1.08), p = 0.028) and previous hospitalisations due to COPD (OR 4.13 (95% CI 1.02 to 16.07), p = 0.041) were associated with the presence of PPMs in the distal airways. The operative characteristics for predicting distal airway infection when patients presented with purulent exacerbation were as follows: sensitivity 89.5%, specificity 76.2%, positive predicted value 77.3% and negative predicted value 88.9%. CONCLUSIONS The self-reporting presence of purulence in the sputum, as well as common previous exacerbations and hospitalisations due to COPD in patients with severe airflow obstruction (FEV1% <50) predict the presence of bacterial infection in the distal airways. The use of these clinical variables may help in selecting candidates to receive antibiotic treatment.
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Affiliation(s)
- Néstor Soler
- Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, IDIBAPS Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
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203
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Punturieri A, Copper P, Polak T, Christensen PJ, Curtis JL. Conserved nontypeable Haemophilus influenzae-derived TLR2-binding lipopeptides synergize with IFN-beta to increase cytokine production by resident murine and human alveolar macrophages. THE JOURNAL OF IMMUNOLOGY 2006; 177:673-80. [PMID: 16785566 PMCID: PMC2373263 DOI: 10.4049/jimmunol.177.1.673] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nontypeable Haemophilus influenzae (NTHi) is strongly associated with exacerbations of chronic obstructive pulmonary disease, which often coincide with viral respiratory infections. TLR2 contributes importantly to innate immunity to NTHi, but whether this pathway is affected by simultaneous antiviral responses is unknown. To analyze potential interactions, resident murine and human alveolar macrophages (AMphi) were exposed, in the presence or absence of the appropriate rIFN-beta, to synthetic lipopeptides corresponding to the triacylated N-terminal fragments of three outer membrane proteins (OMP) (PCP, P4, and P6) that are highly conserved among different NTHi strains. Synthetic OMP elicited strong release of IL-6, the principal inducer of airway mucin genes, and induced CCL5 and CXCL10 from murine AMphi only when IFN-beta was also present. Surprisingly, combined stimulation by OMPs and IFN-beta also markedly enhanced TNF-alpha release by murine AMphi. Stimulation with PCP plus IFN-beta induced IFN-regulatory factor 1 expression and sustained STAT1 activation, but did not alter the activation of MAPKs or NF-kappaB. AMphi derived from STAT1-deficient mice did not demonstrate increased production of TNF-alpha in response to PCP plus IFN-beta. Analysis of wild-type and STAT1-deficient AMphi using real-time PCR showed that increased TNF-alpha production depended on transcriptional up-regulation, but not on mRNA stabilization. The synergistic effect of synthetic OMP and IFN-beta was conserved between murine AMphi and human AMphi for IL-6, but not for TNF-alpha. Thus, IFN-beta, which is produced by virally infected respiratory epithelial cells, converts normally innocuous NTHi OMP into potent inflammatory stimulants, but does so via different mechanisms in mice and humans.
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Affiliation(s)
- Antonello Punturieri
- Pulmonary and Critical Care Medicine Section, and Research Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
- Graduate Program in Immunology, University of Michigan Health System, Ann Arbor, MI 48109
- Address correspondence and reprint requests to Dr. Jeffrey L. Curtis, Pulmonary and Critical Care Medicine Section (506/111G), Department of Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105-2303; E-mail address: or Dr. Antonello Punturieri, National Heart, Lung, and Blood Institute, 2 Rockledge Center, Suite 10018, 6701 Rockledge Drive, Bethesda, MD 20892. E-mail address:
| | - Phil Copper
- Pulmonary and Critical Care Medicine Section, and Research Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105
| | - Timothy Polak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Paul J. Christensen
- Pulmonary and Critical Care Medicine Section, and Research Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Jeffrey L. Curtis
- Pulmonary and Critical Care Medicine Section, and Research Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
- Graduate Program in Immunology, University of Michigan Health System, Ann Arbor, MI 48109
- Address correspondence and reprint requests to Dr. Jeffrey L. Curtis, Pulmonary and Critical Care Medicine Section (506/111G), Department of Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105-2303; E-mail address: or Dr. Antonello Punturieri, National Heart, Lung, and Blood Institute, 2 Rockledge Center, Suite 10018, 6701 Rockledge Drive, Bethesda, MD 20892. E-mail address:
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204
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Malhotra S, Man SFP, Sin DD. Emerging drugs for the treatment of chronic obstructive pulmonary disease. Expert Opin Emerg Drugs 2006; 11:275-91. [PMID: 16634702 DOI: 10.1517/14728214.11.2.275] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
By 2020 chronic obstructive pulmonary disease (COPD) will be the third leading cause of mortality and fifth leading cause of morbidity. Research over the past two decades has shed important insights on the pathobiology of COPD, leading to the development of novel drugs. In the past, symptomatic treatment with bronchodilators was the predominant focus of COPD management. With increased awareness of the importance of airway inflammation in COPD progression, there has been a shift in emphasis to drugs that attack various targets in the inflammatory cascade. These drugs include phosphodiesterase 4 inhibitors, leukotriene modifiers and TNF antagonists, which are poised to enter the COPD market in the very near future. Tyrosine kinase antagonists, inhibitors of NF-kappaB, neutrophil elastase inhibitors, chemokine antagonists, mucolytics and novel antibiotics are being evaluated for possible effectiveness in COPD. Many of these drugs may enter the COPD market within the next decade. This paper reviews the molecular rationale for these emerging drugs and their potential efficacy in COPD.
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Affiliation(s)
- Samir Malhotra
- University of British Columbia & The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Department of Medicine (Respiratory Division), St. Paul's Hospital, Vancouver, British Columbia V6Z 1Y6, Canada.
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205
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Llor C, Maria Cots J, Herreras A. Etiología bacteriana de la agudización de la bronquitis crónica en atención primaria. Arch Bronconeumol 2006. [DOI: 10.1157/13091647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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206
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Burgel PR. [Antibiotics for acute exacerbations of chronic obstructive pulmonary disease (COPD)]. Med Mal Infect 2006; 36:706-17. [PMID: 16839731 DOI: 10.1016/j.medmal.2006.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study had for aim to evaluate the rationale and indications for antibiotic treatment in acute exacerbations of COPD and to identify potential differences among various antibiotics available for the treatment of exacerbations in France. METHODS A search was performed in Medline and for references quoted in identified articles from 1995 to 2005. Open or blind randomized studies involving antibiotics available in France were reviewed. RESULTS About 50% of all exacerbations are related to bacterial infection. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are the main pathogens responsible for bacterial exacerbations. Pseudomonas aeruginosa and enterobacter spp are frequently found in patients with severe functional impairment. Increased purulence of sputum is associated with bacterial infection. Patients with severe functional impairment benefit the most from antibiotic treatment. Although new molecules have larger antibiotic spectrum and better pharmacological properties, the evidence supporting their use compared to standard therapy remains scarce. CONCLUSIONS Additional studies are needed to better identify the subset of patients benefiting from antibiotics and to determine whether new molecules produce significant improvement on relevant outcomes such as exacerbation free interval compared to standard therapy.
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Affiliation(s)
- P-R Burgel
- Service de pneumologie, hôpital Cochin, faculté de médecine, APHP, université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
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207
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Fabbri LM, Luppi F, Beghé B, Rabe KF. Update in Chronic Obstructive Pulmonary Disease 2005. Am J Respir Crit Care Med 2006; 173:1056-65. [PMID: 16679444 DOI: 10.1164/rccm.2603005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Leonardo M Fabbri
- Department of Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy.
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208
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Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect 2006; 12 Suppl 3:42-54. [PMID: 16669928 PMCID: PMC7128137 DOI: 10.1111/j.1469-0691.2006.01396.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The pathological changes in chronic bronchitis (CB) produce airflow obstruction, reduce the effectiveness of the mucocilliary drainage system and lead to bacterial colonisation of bronchial secretion. The presence of bacteria induces an inflammatory response mediated by leukocytes. There is a direct relationship between the degree of impairment of the mucocilliary drainage system, the density of bacteria in mucus and the number of leukocytes in the sputum. Purulent sputum is a good marker of a high bacterial load. Eventually, if the number of leukocytes is high, their normal activity could decrease the effectiveness of the drainage system, increase the bronchial obstruction and probably damage the lung parenchyma. Whenever the density of bacteria in the bronchial lumen is >or=10(6) CFU/mL, there is a high probability that the degree of inflammatory response will lead to a vicious cycle which in turn tends to sustain the process. This situation can arise during the clinical course of any acute exacerbation of CB, independently of its aetiology, provided the episode is sufficiently severe and/or prolonged. Fluoroquinolones of the third and fourth generation are bactericidal against most microorganisms usually related to acute exacerbations of CB. Their diffusion to bronchial mucus is adequate. When used in short (5-day) treatment they reduce the bacterial load in a higher proportion than is achieved by beta-lactam or macrolide antibiotics given orally. Although the clinical cure rate is similar to that obtained with other antibiotics, the time between exacerbations could be increased.
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Affiliation(s)
- J Mensa
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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209
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Guilemany JM, Alobid I, Angrill J, Ballesteros F, Bernal-Sprekelsen M, Picado C, Mullol J. The impact of bronchiectasis associated to sinonasal disease on quality of life. Respir Med 2006; 100:1997-2003. [PMID: 16581240 DOI: 10.1016/j.rmed.2006.02.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 01/25/2006] [Accepted: 02/19/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bronchiectasis (BQs) is an uncommon disease with the potential to cause devastating complications. All patients with BQs have cough and chronic sputum production that may have a great impact on patient's quality of life. Upper airway symptoms are also frequent in patients with BQs. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis and asthma, chronic obstructive lung disease and chronic rhinosinusitis. OBJECTIVE (1) To investigate the impact of bronchiectasis and nasal symptoms on quality of life. (2) To evaluate the added impact of nasal polyposis on quality of life in patients with BQs. METHODS Sixty patients with bronchiectasis and upper airway symptoms were included. Patients were evaluated for nasal symptoms, nasal polyp size by endoscopy, and quality of life using the SF-36 generic questionnaire. RESULTS In comparison with the Spanish general population, patients with BQs had worse scores in all SF-36 domains (P<0.05). Males reported significantly higher quality of life scores on physical functioning and social functioning than females did. Although the age, pulmonary function, presence of nasal polyps, upper airway symptoms, tobacco smoking history, and disease duration was similar between them. Males with BQs had worse quality of life than males from the Spanish general population on body pain, general health, and vitality (P<0.05). Females with BQs had worse quality of life than females from the Spanish general population on physical function, body pain, general health, vitality, social function, and emotional role (P<0.05). Nasal polyps were found in 25 (41.6%) of 60 patients with BQs. No significant differences were observed on quality of life outcomes between patients with BQs with and without nasal polyposis. CONCLUSION These results suggest that BQs has a considerable impact on quality of life while nasal polyposis has no additional impact on the quality of life of patients with BQs.
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Affiliation(s)
- J M Guilemany
- Rhinology Unit, Department of Otorhinolaryngology, Hospital Clinic de Barcelona, ENT, Barcelona, Spain.
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210
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Martinez FJ, Han MK, Flaherty K, Curtis J. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Expert Rev Anti Infect Ther 2006; 4:101-24. [PMID: 16441213 DOI: 10.1586/14787210.4.1.101] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past several years, the significance of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in patients with chronic airflow obstruction has become increasingly apparent due to the impact these episodes have on the natural history of disease. It is now known that frequent AECOPD can adversely affect a patient's health-related quality of life and short- and long-term pulmonary function. The economic burden of these episodes is also substantial. AECOPDs represent a local and systemic inflammatory response to both infectious and noninfectious stimuli, but the majority of episodes are likely related to bacterial or viral pathogens. Patients with purulent sputum and multiple symptoms are the most likely to benefit from treatment with antibiotics. Antibiotic choice should be tailored to the individual patient, taking into account the severity of the episode and host factors which might increase the likelihood of treatment failure. Current evidence suggests that therapeutic goals not only include resolution of the acute episode, but also prolonging the time to the next event. In the future, preventing exacerbations will likely become increasingly accepted as an additional therapeutic goal in chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Fernando J Martinez
- The University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Box 0360, Ann Arbor, MI 48109, USA.
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211
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Sethi S, Maloney J, Grove L, Wrona C, Berenson CS. Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006; 173:991-8. [PMID: 16474030 PMCID: PMC2662918 DOI: 10.1164/rccm.200509-1525oc] [Citation(s) in RCA: 264] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Inflammation is now recognized as an integral part of the pathogenesis of chronic obstructive pulmonary disease (COPD). In contrast to the sterile airways of normal lungs, bacterial pathogens are often isolated from the airways in stable COPD. This "colonization" of the tracheobronchial tree, currently believed to be innocuous, could serve as an inflammatory stimulus, independent of current tobacco smoke exposure. OBJECTIVE To test the hypothesis that bacterial colonization is associated with airway inflammation in stable COPD. METHODS Bronchoscopy with bronchoalveolar lavage (BAL) was performed in three groups of subjects: 26 ex-smokers with stable COPD (COPD), 20 ex-smokers without COPD (ex-smokers), and 15 healthy nonsmokers (nonsmokers). Quantitative bacterial cultures, cell counts, chemokine, cytokine, proteinase/antiproteinase, and endotoxin levels in the BAL fluid were compared. RESULTS Potentially pathogenic bacteria were recovered at > or = 100 cfu/ml in 34.6% of COPD, 0% of ex-smokers, and in 6.7% of nonsmokers (p = 0.003). All values are expressed as median (interquartile range). Subjects with colonized COPD had significantly greater relative (12.0 [28.4] vs. 3.0 [7.8]%, p = 0.03) and absolute (4.98 [5.26] x 10(4)/ml vs. 3.04 [2.82] x 10(4)/ml, p = 0.02) neutrophil counts, interleukin 8 (33.8 [189.8] vs. 16.9 [20.1] pg/ml, p = 0.005), active matrix metalloproteinase-9 (2.16 [4.30] vs. 0.84 [0.99] U/ml, p = 0.03), and endotoxin (36.0 [72.6] vs. 3.55 [7.17] mEU/ml, p = 0.004) levels in the BAL than the subjects with noncolonized COPD. These inflammatory constituents of BAL were also significantly elevated in subjects with colonized COPD when compared with ex-smokers and nonsmokers. CONCLUSIONS Bacterial colonization is associated with neutrophilic airway lumen inflammation in ex-smokers with COPD and could contribute to progression of airway disease in COPD.
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Affiliation(s)
- Sanjay Sethi
- Division of Pulmonary/Critical Care and Sleep Medicine, and Division of Infectious Diseases, Department of Medicine, University at Buffalo, Buffalo, NY, USA.
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212
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Affiliation(s)
- Sanjay Sethi
- Department of Medicine, Division of Pulmonary and Critical Care and Sleep Medicine, University at Buffalo SUNY, Department of Veterans Affairs Western New York Healthcare System.
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213
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[Pseudomonas and the lung]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:7-11. [PMID: 16604034 DOI: 10.1016/s0761-8417(06)75406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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214
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Lee KH. Clinical Year Review of COPD. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.61.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kwan-Ho Lee
- Division of Pulmonary-Allergology, Department of Internal Medicine Yeungnam University College of Medicine, Daegu, Republic of Korea
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215
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Blasi F, Ewig S, Torres A, Huchon G. A review of guidelines for antibacterial use in acute exacerbations of chronic bronchitis. Pulm Pharmacol Ther 2005; 19:361-9. [PMID: 16289762 DOI: 10.1016/j.pupt.2005.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 08/09/2005] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
Acute exacerbations of chronic bronchitis (AECB) affect a significant proportion of the adult population worldwide and are associated with a substantial socioeconomic burden. The majority of episodes of AECB are bacterial in aetiology and patients are generally treated empirically with orally administered antibacterial agents. Guidelines for the management of AECB have been developed by a number of national health authorities and international organisations, with the aim of promoting rational selection of antibacterial therapy to minimise the risk of treatment failure and subsequent hospitalisation while containing the development and spread of antibacterial resistance. This paper reviews a number of recently published or updated AECB treatment guidelines, focusing on patient stratification strategies, antibacterial treatment recommendations, and newer antibacterial treatment options, including respiratory fluoroquinolones and the ketolide telithromycin, which have recently been added to a number of national treatment guidelines.
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Affiliation(s)
- Francesco Blasi
- Pad. LITTA, IRCCS Ospedale Maggiore Policlinico, via F. Sforza, 35, 20122, University of Milan, Policlinico, Milan, Italy.
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216
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Conrad C. Does bacterial colonization play a role in acute respiratory failure in chronic obstructive pulmonary disease?*. Crit Care Med 2005; 33:2130-1. [PMID: 16148498 DOI: 10.1097/01.ccm.0000178370.56851.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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