Optimal treatment strategies for acute exacerbations of chronic bronchitis: high-risk patients

Diagnosis of high-risk patients with acute exacerbations of chronic bronchitis (AECB) should include an evaluation of the patient's respiratory function, chest X-ray to exclude pneumonia, and sputum culture. Increasing resistance to amoxicillin, cephalosporins, macrolides, trimethoprim-sulfamethoxazole, and doxycycline means that fluoroquinolones are often the only oral empiric treatment available. Levofloxacin, a new respiratory fluoroquinolone with a wide spectrum of antibacterial activity and no cross-resistance with other classes of antibiotics, can be administered as an intravenous formulation as well as orally. Sequential therapy is easily administered due to its high oral bioavailability, and the dosing schedule can be a convenient once-daily dose. Clinical trials have established that levofloxacin is effective in AECB and is well tolerated.