Chronic bronchitis medical therapy

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Acute exacerbations of chronic bronchitis

• 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