Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis

Christopher J. Destache, Naresh Dewan, Walter J. O'Donohue, J. Clayton Campbell, Vito A. Angelillo

Research output: Contribution to journalArticle

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Abstract

Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P <0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P <0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P <0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 ± 8.76; second-line US$24.45 ± 25.65; third-line US$45.40 ± 11.11; P <0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 ± 2173; second-line, US$563 ± 2296; third-line, US$542 ± 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.

Original languageEnglish
Pages (from-to)107-113
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume43
Issue numberSUPPL. A
StatePublished - 1999

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Chronic Bronchitis
Economics
Costs and Cost Analysis
Amoxicillin-Potassium Clavulanate Combination
Azithromycin
Therapeutics
Ciprofloxacin
Outpatients
Cephradine
Cefaclor
Anti-Bacterial Agents
Tetracyclines
Cefuroxime
Amoxicillin
Sulfamethoxazole Drug Combination Trimethoprim
Erythromycin
Health Care Costs
Chronic Obstructive Pulmonary Disease
Medical Records
Teaching

All Science Journal Classification (ASJC) codes

  • Microbiology
  • Pharmacology

Cite this

Destache, C. J., Dewan, N., O'Donohue, W. J., Campbell, J. C., & Angelillo, V. A. (1999). Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. Journal of Antimicrobial Chemotherapy, 43(SUPPL. A), 107-113.

Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. / Destache, Christopher J.; Dewan, Naresh; O'Donohue, Walter J.; Campbell, J. Clayton; Angelillo, Vito A.

In: Journal of Antimicrobial Chemotherapy, Vol. 43, No. SUPPL. A, 1999, p. 107-113.

Research output: Contribution to journalArticle

Destache, CJ, Dewan, N, O'Donohue, WJ, Campbell, JC & Angelillo, VA 1999, 'Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis', Journal of Antimicrobial Chemotherapy, vol. 43, no. SUPPL. A, pp. 107-113.
Destache, Christopher J. ; Dewan, Naresh ; O'Donohue, Walter J. ; Campbell, J. Clayton ; Angelillo, Vito A. / Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. In: Journal of Antimicrobial Chemotherapy. 1999 ; Vol. 43, No. SUPPL. A. pp. 107-113.
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