Bronchitis

Fluoroquinolones are broad-spectrum antibacterials that have experienced an upsurge in use in recent years. Because of their broad-spectrum activity, high efficacy, favorable dosing, and availability in oral and IV form, these agents are indicated for a range of bacterial infections, including respiratory, GI, and urinary tract infections. Earlier generations of fluoroquinolones (e.g., ofloxacin) had limited activity against some respiratory pathogens, such as S. pneumoniae. However, more recent fluoroquinolone agents (so-called third-generation agents or the “respiratory fluoroquinolones”) are active against a broad spectrum of gram-positive and gram-negative bacteria, including atypical organisms.

Moxifloxacin displays excellent activity against a broad spectrum of bacteria, including penicillin- and macrolide-resistant S. pneumoniae.

Ketolides are a new class of macrolide derivatives designed specifically to combat macro fide-resistant respiratory tract pathogens. The ketolides are semisynthetic derivatives of the macrolide erythromycin A, with a keto group replacing the 1-cladinose group at position 3 of the macrolactone ring. The ketolides exhibit good activity against gram-positive and some gram-negative organisms, and have excellent activity against drug-resistant S. pneumoniae, including macrolide-resistant strains.

Macrolides inhibit bacterial protein synthesis. They demonstrate excellent activity against atypical organisms (Mycoplasma, Chlamydia, and Legionella species), but their activity against typical pathogens (H. influenzae and S. pneumoniae) is variable. Macrolides are indicated for use in acute exacerbations of chronic bronchitis and are typically used as first- and second-line agents for this indication.

Carbapenems are penicillin derivatives that have good activity against gram-positive and gram-negative aerobic and anaerobic bacteria. They are highly resistant to β-lactamase and have a very favorable spectrum of activity. A drawback of these agents is that they are available in IV form only.

The cephalosporins contain a basic β-lactam structure fused to a six-membered ring. Drugs in this class differ widely in their spectrum of activity, susceptibility to β-lactamases produced by bacteria, and serum half-life. Cephalosporins are categorized into four generations, with each newer generation representing an improvement in the spectrum of bacterial coverage. First-generation agents have the narrowest spectrum of activity among the cephalosporins.

Cefotaxime is indicated for the treatment of lower respiratory tract infections caused by S. pneumoniae and other streptococci, E. coli, K. pneumoniae and other Klebsiella species, H. influenzae (including ampicillin-resistant strains).

Cefdinir (Abbott’s Omnicef, Fujisawa’s Cefzon) is a third-generation, oral cephalosporin available in capsule and oral suspension forms. Cefdinir was developed and launched by Fujisawa in Japan in 1991 as Cefzon.

The penicillins comprise several subgroups of agents with a wide range of bacterial coverage and efficacy. Each penicillin molecule contains a basic β-lactam structure fused to a five-membered ring. Because of their broad spectrum of activity and availability in oral form, the penicillins are commonly used in the treatment of acute exacerbations of chronic bronchitis and have become the drugs of choice in treating many common infections. The penicillins are further divided into the following groups: natural penicillins, aminopenicillins, and the extended-spectrum penicillins.

TABLE: Pharmacological Management of Underlying Disease During an Acute Exacerbation of Chronic Bronchitis summarizes the general pharmacological agents and classes used to manage acute exacerbations of chronic bronchitis. The primary therapies used in acute exacerbations of chronic bronchitis treat the causative infection (antibiotics), relieve symptoms (bronchodilators), and treat the underlying inflammation (corticosteroids). TABLE: Current Therapies Used for Acute Exacerbations of Chronic Bronchitis summarizes the leading antibiotic therapies used to treat the infection.