Chronic bronchitis medical therapy: Difference between revisions
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{{Chronic bronchitis}} | {{Chronic bronchitis}} | ||
===Acute exacerbations of chronic bronchitis=== | |||
:* '''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== | ||
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[[Category:General practice]] | [[Category:General practice]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Infectious Disease Project]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 18:56, 12 August 2015
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Acute exacerbations of chronic bronchitis
- Acute exacerbation of chronic bronchitis[1]
- 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
- ↑ Sethi S, Murphy TF (2004). "Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy". Infect Dis Clin North Am. 18 (4): 861–82, ix. doi:10.1016/j.idc.2004.07.006. PMID 15555829.