Chronic bronchitis medical therapy

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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.

Medical Therapy

Acute exacerbation of chronic bronchitis

Antimicrobial Regimen

• Acute exacerbation of chronic bronchitis

• 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