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- Title
Clinical and economic considerations in the treatment of acute exacerbations of chronicbronchitis.
- Authors
Destache, Christopher J.; Dewan, Naresh; O'Donohue, Walter J.; Campbell, J. Clayton; Angelillo, Vito A.
- Abstract
Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation ofchronicbronchitis (AECB). Therefore, the main objective of this study was to determine theantimicrobialefficacy and related costs for patients with AECB. A retrospective review of 60 outpatientmedicalrecords with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronicbronchitisepisodes from a pulmonary clinic of a teaching institution was undertaken. The participatingpatients hada total of 224 episodes of AECB requiring antibiotic treatment. Before review, empiricalantibioticchoices 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 thanthird-line agents (19% vs 7%, P <0.05). Additionally, patients prescribedfirst-lineagents were hospitalized significantly more often for AECB within 2 weeks of outpatienttreatment ascompared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P <0.02). Time between subsequent AECB episodes requiring treatment wassignificantly longerfor 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-lineUS$942 ± 2173; second-line, US$563 ± 2296; third-line, US$542 ±1946).The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantlyreducedthe failure rate and need for hospitalization, prolonged the time between AECB episodes, andshoweda lower total cost for the management of AECB. Prospective studies are needed to confirm thesefindings.
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 1999, Vol 43, Issue suppl_1, p107
- ISSN
0305-7453
- Publication type
Article
- DOI
10.1093/jac/43.suppl_1.107