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Acute bronchitis

Acute bronchitis. Cough lasting for more than five days (+/- sputum) Almost all episodes due to viruses Mycoplasma, Chlamydia, Bordetella responsible for a minority. Symptomatic treatment. Indications for antibiotic treatment in COPD exacerbations. Anthonisen type 1 patients

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Acute bronchitis

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  1. Acute bronchitis • Cough lasting for more than five days (+/- sputum) • Almost all episodes due to viruses • Mycoplasma, Chlamydia, Bordetella responsible for a minority. • Symptomatic treatment

  2. Indications for antibiotic treatment in COPD exacerbations • Anthonisen type 1 patients • Type 2 patients with purulent sputum • Severe exacerbations necessitating mechanical ventilation

  3. * Although detected at exacerbations, it is not clear whether Chlamydia is a true infective agent and whether it needs to be covered by antimicrobial treatment. ** Amoxicillin should be given to patients in whom sputum culture reveals penicillin- sensitive S.pneumoniaeor non-beta-lactamase producing bacteria.

  4. Risk factors for treatment failure / early recurrence in COPD exacerbations • Presence of comorbidity (especially cardiac disease) • Severe COPD (FEV1<50%) • > 3 exacerbations during the preceding year • Antibiotic use in the last 3 months

  5. Risk factors for P. aeruginosa in exacerbations of COPD and bronchiectasis • Hospitalization during the last month • Antibiotic use during the preceding month or for  four times during the preceding year • Exacerbations leading to respiratory failure • Isolation of P. aeruginosa from respiratory samples in the previous exacerbation or in the stable period

  6. * First choice in patients who have been treated with a beta-lactam during the preceding three months or who are allergic to penicillin. Because of their effectiveness against potential pathogens, high concentrations in lung tissue and respiratory secretions and efficacy for eradication, these FQ’s can be used as first choices; however it must be remembered that frequent use may be associated with increases in resistance rates. #Gemifloxacin

  7. * Sputum culture and susceptibility tests are recommended in these patients. Empiric treatment can thsu be modified according to the results of these tests and a narrower- spectrum antibiotic can be chosen.

  8. Recommendations for antibiotics in exacerbations of bronchiectasis * Sputum culture and susceptibility tests are recommended in these patients. #An antibiotic active against Gram + bacteria must be added in cases with IgG deficiency

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