Future antibiotic trials

The true value of antibiotics in acute exacerbations of chronic bronchitis remains to be defined. Although short-term benefits are generally accepted, if prescription volume is an indicator, there is little evidence to support their use in mild exacerbations.Thus, most therapeutic episodes are probably unnecessary and certainly encourage bacterial resistance. In more severe exacerbations, trials must be designed to validate the potential benefits-if they exist-of pharmacologically-improved antibiotics by demonstration of both short- and longer-term benefits. The relevance of standard bacteriological and short-term clinical outcome assessments must be questioned. Alternative outcome measures, e.g., quality of life, may allow differentiation of antibiotic classes. Long-term assessment of symptom-free intervals, related to baseline status, might open pathways to the prevention of progressive, bacteria-initiated inflammatory damage to small airways. There is little excuse for continued ignorance of the nature of bacterial involvement in chronic bronchitis and the potential for more effective therapy.