Antibacterials and acute exacerbation of chronic bronchitis: Issues for formulary decision makers

The utility of antibacterials in the management of acute exacerbations of chronic bronchitis (AECB) and the related lung pathology, chronic obstructive pulmonary disease (COPD), has been debated for decades. Data presented in this article document that more expensive antimicrobials may be favored in AECB treatment to prevent adverse outcomes to patients, namely antimicrobial failure and hospitalization. Identified patient-specific variables that may lead to treatment failure include right- or left-sided heart failure and ≥4 exacerbations/year. Risk factors for hospitalization include age ≥65 years and severe pulmonary and nonpulmonary dysfunction. However, these risk factors have never been formally validated in a prospective, randomized trial. Drug-resistant organisms have not been documented to cause antimicrobial failure or hospitalization, however, more data are needed in this growing area.