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Journal of Antimicrobial Chemotherapy (1999) 43, Suppl. A, 107-113
© 1999 The British Society for Antimicrobial Chemotherapy

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 and Vito A. Angelillo

Schools of Pharmacy & Allied Health Professions and Medicine, Creighton University, Omaha, NE, USA

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.

* Corresponding address: Creighton University School of Pharmacy and AHP, Criss III Rm 369, 2500 California Plaza, Omaha, NE 68178, USA. Tel: +1-402-280-4744; Fax: +1-402-280-1268; E-mail: CDestach{at}creighton.edu


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