Anzueto A
The University of Texas Health Science Center at San Antonio and The South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, 78284, USA.
Semin Respir Crit Care Med. 2000;21(2):97-106. doi: 10.1055/s-2000-9843.
Acute exacerbation of chronic bronchitis (AECB) is a condition associated with increased morbidity and mortality. Bacterial infections are the most frequent cause of exacerbations. The most common bacterial etiologies include Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumonia. The diagnosis of AECB is often based on the clinical presentation, but microbiological assessment, including Gram stain and sputum culture should be done. Antibiotic therapy should be used in patients with the following characteristics: underlying lung disease, frequent exacerbations, and comorbid conditions. Penicillins, erythromycin, beta-lactamase inhibitors, and trimethoprim-sulfamethoxazole have been the preferred antibiotics. However, because of the increasing prevalence of resistance among respiratory pathogens, mainly the production of beta-lactamase by H. influenzae and M. catarrhalis, and the emergence of multidrug-resistant S. pneumonia, new generation macrolides and fluoroquinolones should be the first line of treatment in selected patients. These drugs have increased efficacy and safety.
慢性支气管炎急性加重（AECB）是一种与发病率和死亡率增加相关的病症。细菌感染是加重病情的最常见原因。最常见的细菌病因包括流感嗜血杆菌、卡他莫拉菌和肺炎链球菌。AECB的诊断通常基于临床表现，但应进行微生物学评估，包括革兰氏染色和痰培养。具有以下特征的患者应使用抗生素治疗：潜在肺部疾病、频繁加重以及合并症。青霉素、红霉素、β-内酰胺酶抑制剂和甲氧苄啶-磺胺甲恶唑一直是首选抗生素。然而，由于呼吸道病原体耐药性的日益普遍，主要是流感嗜血杆菌和卡他莫拉菌产生β-内酰胺酶，以及多重耐药肺炎链球菌的出现，新一代大环内酯类药物和氟喹诺酮类药物应作为特定患者的一线治疗药物。这些药物具有更高的疗效和安全性。
