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Acute Exacerbations of Chronic Bronchitis

What Role for the New Fluoroquinolones?

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Abstract

Acute exacerbations of chronic bronchitis (AECB) are a major cause of morbidity and mortality. Bacterial pathogens are implicated in about half the episodes of AECB. Empirical antibacterials have a significant benefit in AECB; however, several recent developments have considerably complicated antibacterial choice for this condition. New fluoroquinolone antibacterials introduced in the last decade are theoretically well suited for the treatment of AECB, as the in vitro antimicrobial spectrum of these drugs includes all the major pathogens involved. The pharmacokinetic and pharmacodynamic properties of the new fluoroquinolones are superior to many other antibacterials used to treat AECB. In trials, clinical success with the new fluoroquinolones was equivalent and bacteriological success was occasionally superior to nonfluoroquinolone comparators. However, these clinical trials did not assess several potentially important end-points for which the theoretical superiority of the fluoroquinolones may translate into differences in outcome. Rare but serious adverse effects with some of the new fluoroquinolones have shaken the confidence of prescribing physicians in this class of drugs. Emergence of the resistance of Streptococcus pneumoniae to fluoroquinolones has raised concerns about indiscriminate and widespread use of the new agents for trivial infections. Patients with AECB are a heterogeneous population who should be stratified in order to appropriately choose empirical antibacterial therapy. Highly efficacious antibacterial therapy, such as the new fluoroquinolones, is appropriate as a first-line choice for patients who have risk factors for a poor outcome or are in intensive care units. Such selected use of the new fluoroquinolones balances individual benefit with societal concerns of the use of these agents for AECB.

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References

  1. National Heart Lung and Blood Institute. Morbidity and mortality chartbook on cardiovascular, lung and blood diseases. National Institutes of Health: Bethesda (MD), 1998

    Google Scholar 

  2. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997; 278: 901–4

    Article  PubMed  CAS  Google Scholar 

  3. Doern GV, Jones RN, Pfaller MA, et al., SENTRY Participants Group. Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired respiratory tract infections: antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997). Antimicrob Agents Chemother 1999; 43(2): 385–9

    PubMed  CAS  Google Scholar 

  4. Doern GV, Pfaller MA, Kugler K, et al. Prevalence of antimicrobial resistance amount respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY Antimicrobial Surveillance Program. Clin Infect Dis 1998; 27: 764–70

    Article  PubMed  CAS  Google Scholar 

  5. Murphy TF, Sethi S. Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis 1992; 146: 1067–83

    PubMed  CAS  Google Scholar 

  6. Sethi S. Etiology and management of infections in chronic obstructive pulmonary disease. Clin Pulm Med 1999; 6(6): 327–32

    Article  Google Scholar 

  7. Moss PJ, Finch RG. The next generation: fluoroquinolones in the management of acute lower respiratory infection in adults. Thorax 2000; 55: 83–5

    Article  PubMed  CAS  Google Scholar 

  8. Mommeja-Marin H, Carbon C. What is the place of fluoroquinolones in the treatment of community-acquired respiratory tract infections? Drugs 1999; 57(6): 851–3

    Article  PubMed  CAS  Google Scholar 

  9. Piddock LJV. Fluoroquinolone resistance: overuse of fluoroquinolones in human and veterinary medicine can breed resistance. BMJ 1998; 317: 1029–30

    Article  PubMed  CAS  Google Scholar 

  10. Hooper DC. Expanding uses of fluoroquinolones: opportunities and challenges. Ann Intern Med 1998; 129(11): 908–10

    PubMed  CAS  Google Scholar 

  11. Ball P. Therapy for pneumococcal infection at the millennium: doubts and certainties. Am J Med 1999; 107(1A): 77S–85S

    Article  PubMed  CAS  Google Scholar 

  12. Wilson R, Kubin R, Ballin I, et al. Five-day moxifloxacin therapy compared with 7-day clarithromycin therapy for the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 44: 501–13

    Article  PubMed  CAS  Google Scholar 

  13. Shah PM, Maesen FPV, Dolmann A, et al. Levofloxacin versus cefuroxime axetil in the treatment of acute exacerbation of chronic bronchitis: results of a randomized, double-blind study. J Antimicrob Chemother 1999; 43: 529–39

    Article  PubMed  CAS  Google Scholar 

  14. Read RC, Kuss A, Berrisoul F, et al. The efficacy and safety of a new ciprofloxacin suspension compared with co-amoxiclav tablets in the treatment of acute exacerbations of chronic bronchitis. Respir Med 1999; 93: 252–61

    Article  PubMed  CAS  Google Scholar 

  15. Langan CE, Zuck P, Vogel F, et al. Randomized, double-blind study of short-course (5 day) grepafloxacin versus 10 day clarithromycin in patients with acute bacterial exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 44: 515–23

    Article  PubMed  CAS  Google Scholar 

  16. Langan CE, Cranfield R, Breisch S, et al. Randomized, doubleblind study of grepafloxacin versus amoxicillin in patients with acute bacterial exacerbations of chronic bronchitis. J Antimicrob Chemother 1997; 40: 63–72

    Article  PubMed  CAS  Google Scholar 

  17. Langan C, Clecner B, Cazzola CM, et al. Short-course cefuroxime axetil therapy in the treatment of acute exacerbations of chronic bronchitis. Int J Clin Pract 1998; 52(5): 289–97

    PubMed  CAS  Google Scholar 

  18. Habib MP, Gentry LO, Rodriguez-Gomez G, et al. Multicenter, randomized study comparing efficacy and safety of oral levofloxacin and cefaclor in treatment of acute bacterial exacerbations of chronic bronchitis. Infect Dis Clin Pract 1998; 7: 101–9

    Article  Google Scholar 

  19. Davies BI, Maesen FPV. Clinical effectiveness of levofloxacin in patients with acute purulent exacerbations of chronic bronchitis: the relationship with in vitro activity. J Antimicrob Chemother 1999; 43 Suppl. C: 83–90

    Article  PubMed  CAS  Google Scholar 

  20. Chodosh S, Lakshminarayan S, Swarz H, et al. Efficacy and safety of a 10-day course of 400 or 600 milligrams of grepafloxacin once daily for treatment of acute bacterial exacerbations of chronic bronchitis: comparison with a 10-day course of 500 milligrams of ciprofloxacin twice daily. Antimicrob Agents Chemother 1998; 42(1): 114–20

    Article  PubMed  CAS  Google Scholar 

  21. Chodosh S, McCarty J, Farkas S, et al. Randomized, doubleblind study of ciprofloxacin and cefuroxime axetil for treatment of acute bacterial exacerbations of chronic bronchitis. Clin Infect Dis 1998; 27: 722–9

    Article  PubMed  CAS  Google Scholar 

  22. Chodosh S, Schreurs JM, Siami G, et al. Efficacy of oral ciprofloxacin vs clarithromycin for treatment of acute bacterial exacerbations of chronic bronchitis. Clin Infect Dis 1998; 27: 730–8

    Article  PubMed  CAS  Google Scholar 

  23. DeAbate CA, Henry D, Bensch G, et al. Sparfloxacin vs ofloxacin in the treatment of acute bacterial exacerbations of chronic bronchitis: a multicenter, double-blind, randomized, comparative study. Chest 1998; 114: 120–30

    Article  PubMed  CAS  Google Scholar 

  24. Allegra L, Konietzko N, Leophonte P, et al. Comparative safety and efficacy of sparfloxacin in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a doubleblind, randomised, parallel, multicentre study. J Antimicrob Chemother 1996; 37 Suppl A: 93–104

    Article  PubMed  CAS  Google Scholar 

  25. Anzueto A, Niederman MS, Tillotson GS, et al. Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: ciprofloxacin 750 mg BID vs clarithromycin 500 mg BID. Clin Ther 1998; 20(5): 885–900

    Article  PubMed  CAS  Google Scholar 

  26. Blondeau JM. Areview of the comparative in-vitro activities of 12 antimicrobial agents, with a focus on five new ‘respiratory quinolones’. J Antimicrob Chemother 1999; 43 Suppl. B: 1–11

    Article  PubMed  CAS  Google Scholar 

  27. Methods for dilution antimicrobial susceptiblity tests for bacteria that grow aerobically: approved standard. 5th ed. Wayne (PA), National Committee for Clinical Laboratory Standards, 2000

  28. Chen DK, McGeer A, de Azavedo JC, et al., Canadian Bacterial Surveillance Network. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999; 341: 233–9

    Article  PubMed  CAS  Google Scholar 

  29. Linares J, de la Dampa AG, Pallares R. Fluoroquinolone resistance in Streptococcus pneumoniae. N Engl J Med 1999; 341(20): 1546–8

    PubMed  CAS  Google Scholar 

  30. Wise R, Honeybourne D. Pharmacokinetics and pharmacodynamics of fluoroquinolones in the respiratory tract. Eur Respir J 1999; 14: 221–9

    Article  PubMed  CAS  Google Scholar 

  31. Balfour JAB, Wiseman LR. Moxifloxacin. Drugs 1999; 57(3): 363–73

    Article  PubMed  CAS  Google Scholar 

  32. Perry CM, Balfour JAB, Lamb H. Gatifloxacin. Drugs 1999; 58(4): 683–96

    Article  PubMed  CAS  Google Scholar 

  33. Goa KL, Bryson HM, Markham A. Sparfloxacin: a review of its antibacterial activity, pharmacokinetic properties, clinical efficacy and tolerability in lower respiratory tract infections. Drugs 1997; 53(4): 700–25

    Article  PubMed  CAS  Google Scholar 

  34. Martin SJ, Meyer JM, Chuck SK, et al. Levofloxacin and sparfloxacin: new quinolone antibiotics. Ann Pharmacother 1998; 32: 320–36

    Article  PubMed  CAS  Google Scholar 

  35. Wise R, Andrews JM. The in-vitro activity and tentative breakpoint of gemifloxacin, a new fluoroquinolone. J Antimicrob Chemother 1999; 44: 679–88

    Article  PubMed  CAS  Google Scholar 

  36. Schentag JJ, Goss TF. Quinolone pharmacokinetics in the elderly. Am J Med 1992; 92 Suppl. 4A: 33S–7S

    Article  PubMed  CAS  Google Scholar 

  37. Grasela DM. Clinical pharmacology of gatifloxacin, a new fluoroquinolone. Clin Infect Dis 2000; 31Suppl. 2: S51–8

    Article  PubMed  CAS  Google Scholar 

  38. Donati M, Fermepin MR, Olmo A, et al. Comparative in-vitro activity of moxifloxacin, minocycline and azithromycin against Chlamydia spp. J Antimicrob Chemother 1999; 43: 825–7

    Article  PubMed  CAS  Google Scholar 

  39. van Schilfgaarde M, Eijk PP, Regelink A, et al. Haemophilus influenzae localized in epithelial cell layers is shielded from antibiotics and antibody-mediated bactericidal activity. Microb Pathogen 1999; 26: 249–62

    Article  Google Scholar 

  40. Williams RL, Chalmers TC, Stange KC, et al. Use of antibiotics inpreventing recurrent acute otitis media and in treating otitis media with effusion. JAMA 1993; 270(11): 1344–51

    Article  PubMed  CAS  Google Scholar 

  41. Lipsky BA, Baker CA. Fluoroquinolone toxicity profiles: a review focusing on newer agents. Clin Infect Dis 1999; 28: 352–64

    Article  PubMed  CAS  Google Scholar 

  42. De Ponti F, Poluzzi E, Montanaro N. QT-interval prolongation by non-cardiac drugs: lessons to be learned from recent experience. Eur J ClinPharmacol 2000; 56(1): 1–18

    Article  Google Scholar 

  43. Ball P. Quinolone-induced QT interval prolongation: a not-so-unexpected class effect. J Antimicrob Chemother 2000; 45: 557–9

    Article  PubMed  CAS  Google Scholar 

  44. Man I, Murphy J, Ferguson J. Fluoroquinolone phototoxicity: a comparison of moxifloxacin and lomefloxacin in normal volunteers. J Antimicrob Chemother 1999; 43 Suppl. B: 77–82

    Article  PubMed  CAS  Google Scholar 

  45. Jones ME, Sahm DF, Martin N, et al. Prevalence of gyrA, gyrB, parC, and parE mutations in clinical isolates of Streptococcus pneumoniae with decreased susceptibilities to different fluoroquinolones and originating from worldwide surveillance studies during the 1997–1998 respiratory season. Antimicrob Agents Chemother 2000; 44(2): 462–6

    Article  PubMed  CAS  Google Scholar 

  46. Zeller V, Janoir C, Kitzis M-D, et al. Active efflux as a mechanism of resistance to ciprofloxacin in Streptococcus pneumoniae. Antimicrob Agents Chemother 1997; 41(9): 1973–8

    PubMed  CAS  Google Scholar 

  47. Zhao X, Xu C, Domagala J, et al. DNA topoisomerase targets of the fluoroquinolones: a strategy for avoiding bacterial resistance. Proc Natl Acad Sci U S A 1997; 94: 13991–6

    Article  PubMed  CAS  Google Scholar 

  48. Soler N, Torres A, Ewig S, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998; 157: 1498–505

    PubMed  CAS  Google Scholar 

  49. Balter MS. Recommendations on the management of chronic bronchitis: a practical guide for Canadian physicians. Can Med Assoc J 1994; 151(10): 5–23

    Google Scholar 

  50. Grossman R, Mukherjee J, Vaughan D, et al. A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 1998; 113: 131–41

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors wish to thank Adeline Thurston for her secretarial assistance.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, State University of New York at Buffalo, New York, USA

    Adel Obaji &  Sanjay Sethi

  2. Department of Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA

    Sanjay Sethi

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  1. Adel Obaji
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  2. Sanjay Sethi
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Correspondence to Sanjay Sethi.

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Obaji, A., Sethi, S. Acute Exacerbations of Chronic Bronchitis. Drugs & Aging 18, 1–11 (2001). https://doi.org/10.2165/00002512-200118010-00001

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