Chest
Part 1: Beating BronchitisGuidelines for the Treatment of Acute Exacerbations of Chronic Bronchitis
Section snippets
BACTERIAL PATHOGENS
Gump et al13 demonstrated that two thirds of all exacerbations are bacterial in origin. Haemophilus influenzae is the most commonly isolated organism from sputum in patients with acute exacerbations of chronic obstructive lung disease, but other Haemophilus species, Streptococcus pneumoniae, and Moraxella catarrhalis may also be found.14 Two studies utilizing the protected specimen brush technique, in which pure lower respiratory tract samples were obtained, indicated that the organisms
DEFINITION OF RISK FACTORS
It would be preferable to define a target population at risk based on severity of disease as has been done for patients with pneumonia.20 For example, patients with significant compromise of lung function may develop acute respiratory failure as a consequence of an acute exacerbation. Among these patients, 20 to 60% require mechanical ventilation, average hospital and ICU length of stays are long and expensive, and hospital mortality rates range from 10 to 30%.21 In North America, factors
STRATIFICATION OF PATIENTS ACCORDING TO RISK FACTORS
Therapeutic failure might be expected to lead to more hospitalizations, increased costs due to extra physician visits, prolonged absences from work, further diagnostic tests, and repeated courses of antibiotics in high-risk individuals. Routine chemotherapy fails in 13 to 25% or more of exacerbations.25, 26 Simple stratification of patients into risk categories should allow the physician to identify high-risk individuals and select targeted antimicrobial therapy to prevent some of these
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Cited by (82)
Short- vs Long-Course Antibiotics for Acute Exacerbations of Chronic Bronchitis
2012, Journal for Nurse PractitionersAntibiotic Prescribing for Acute Respiratory Infection and Subsequent Outpatient and Hospital Utilization in Veterans With Spinal Cord Injury and Disorder
2010, PM and RCitation Excerpt :Little research has been conducted describing antibiotic prescribing trends in persons with SCI/D, although persons with SCI/D are commonly prescribed antibiotics for various conditions. Antibiotic treatment is generally not recommended for conditions such as URIs and acute bronchitis [6,7], excluding those with acute exacerbations of chronic bronchitis [28]. The study authors previously assessed trends in antibiotic use in veterans with SCI/D who were seen in outpatient settings for ARIs [25] and found that 55.9% of nonpneumonic lower respiratory infection visits (95% of which were for acute bronchitis) led to prescriptions of antibiotics, whereas 51.1% of URI visits (78% of which were for the common cold and nonspecific URI) resulted in antibiotic prescriptions.
Chronic cough: State-of-the-art review
2006, Otolaryngology - Head and Neck SurgeryAntimicrobial treatment of lower respiratory tract infections in the hospital setting
2005, American Journal of MedicineCitation Excerpt :In addition, patients with significant compromise of lung function may develop respiratory failure as a consequence of an acute exacerbation, and up to 60% of these patients will require mechanical ventilation.42 Hospital mortality rates from severe AECB range from 10% to 30% for patients with significant compromise of lung function.42 In those patients most likely to be hospitalized, current guidelines recommend treatment with medications such as fluoroquinolones to provide coverage for resistant organisms.41