|
|
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{Chronic bronchitis}} | | {{Chronic bronchitis}} |
| {{CMG}} {{AE}} | | {{CMG}} {{AE}}{{MehdiP}} |
| | |
| ==Overview== | | ==Overview== |
| Antimicrobial therapy is the mainstay of therapy in acute exacerbation of chronic bronchitis. Patients with severe disease and existing comorbidities require hospital admission. When pseudomonas infection is suspected, the preferred regimen for inpatient management includes either [[Cephalosporins]] or [[Piperacillin-Tazobactam]].
| | There are two main goal of chronic bronchitis treatment: |
| | | #'''Reduce symptoms:''' by relief of dyspnea and improve exercise tolerance |
| ==Medical Therapy==
| | #'''Reduce risks:''' by treating exacerbations, preventing disease progression and reducing mortality |
| ===Acute exacerbation of chronic bronchitis===
| |
| ====Antimicrobial Regimen====
| |
| :* '''Acute exacerbation of chronic bronchitis'''<ref name="pmid15555829">{{cite journal| author=Sethi S, Murphy TF| title=Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy. | journal=Infect Dis Clin North Am | year= 2004 | volume= 18 | issue= 4 | pages= 861-82, ix | pmid=15555829 | doi=10.1016/j.idc.2004.07.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15555829 }} </ref>
| |
| ::* '''1. Outpatient management'''
| |
| :::* Patients with only 1 of the 3 cardinal symptoms of COPD (↑ dyspnea, ↑ sputum volume, ↑ sputum purulence) may not benefit from antibiotics
| |
| :::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7-10 days
| |
| :::* Preferred regimen (2): [[Amoxicillin]] 875 mg PO bid
| |
| :::* Preferred regimen (3): [[Amoxicillin]] 500 mg PO tid
| |
| :::* Preferred regimen (4): [[Trimethoprim-sulfamethoxazole]] DS 800/160 mg PO bid for 10-14 days
| |
| :::* Alternative regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid for 10-14 days
| |
| :::* Alternative regimen (2): [[Levofloxacin]] 500 mg PO qd for 7-10 days
| |
| :::* Alternative regimen (3): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd for 4 days
| |
| :::* Alternative regimen (4): [[Cefpodoxime]] 200 mg PO bid for 10 days
| |
| :::* Alternative regimen (5): [[Amoxicillin-clavulanate]] 500/125 mg PO tid for 10-14 days
| |
| :::* Alternative regimen (6): [[Moxifloxacin]] 400 mg PO qd for 5 days
| |
| :::* Alternative regimen (7): [[Gemifloxacin]] 320 mg PO qd for 5 days
| |
| :::* Alternative regimen (8): [[Clarithromycin]] 250-500 mg PO bid for 7-14 days
| |
| :::* Alternative regimen (9): [[Clarithromycin]] ER 1000 mg PO qd for 14 days
| |
| :::* Alternative regimen (10): [[Cefprozil]] 250-500 mg PO bid for 10 days
| |
| :::* Alternative regimen (11): [[Cefixime]] 400 mg PO qd for 10 days
| |
| ::* '''2. Inpatient management'''
| |
| :::* Indications for hospital admission:
| |
| ::::* Intense symptoms (e.g.: sudden development of resting dyspnea)
| |
| ::::* Old age
| |
| ::::* Severe underlying COPD
| |
| ::::* Cyanosis
| |
| ::::* Peripheral edema
| |
| ::::* Serious comorbidities (e.g.: HF, Afib, renal failure)
| |
| ::::* Failure of outpatient treatment
| |
| ::::* Frequent exacerbations
| |
| ::::* Insufficient home support
| |
| :::* 2.1 '''Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection not suspected'''
| |
| ::::* Preferred regimen (1): [[Moxifloxacin]] 400 mg IV q24h for 5 days
| |
| ::::* Preferred regimen (2): [[Levofloxacin]] 500 mg IV q24h for 7-10 days
| |
| :::* 2.2 '''Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection is suspected'''
| |
| ::::* Preferred regimen (1): [[Ceftazidime]] 30-50 mg/kg IV q8hr (maximum dose 6 g/day)
| |
| ::::* Preferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days
| |
| ::::* Preferred regimen (3): [[Cefepime]] 1-2 g IV q8-12hr for 7-10 days (extend to 21 days if culture positive for Pseudomonas)
| |
| ::::* Alternative regimen (1): [[Ceftriaxone]] 1-2 g IV/IM q12-24h for 4-14 days
| |
| ::::* Alternative regimen (2): [[Ceftriaxone]] 1-2 g IV/IM q8h for 4-14 days
| |
| | |
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |