Acute exacerbation of chronic bronchitis: patients, antibiotherapy, and guidelines

Objective. - The aim of this study was to compare antibiotic prescriptions made by general practitioners to French recommendations for the management of Acute Exacerbation of Chronic Bronchitis (AECB) referring to the patient's socio-demographic data, history of Chronic Bronchitis (CB), current episode management, and quality of life. Methods. - This cross-sectional study was made on 101 general practitioners. Results. - Four hundred eighteen patients were included: mean age: 66+/-12 years; male patients 71%; mean history of CB: 13 years; cardiac comorbidity: 45%; depression: 34%; obstructive ventilatory syndrome: 64%; respiratory functional test performed: 44%; FEV1<35%: 10%. An antibiotic was prescribed in 95% of cases. 94% of treated patients were classified as type I or 2, according to Anthonisen's criteria: 85% of these presented with purulent expectoration. The classification used in French recommendations was applied in 364/418 patients, 79 had simple CB, 231 had moderate obstructive CB, 43 had severe obstructive CB. The antibiotic (AB) prescriptions concerned mostly group 2. Group 2 AB were over-prescribed in 70% of patients suffering from obstructive CB or simple CB. But group 2 AB were under-prescribed in 25% of patients suffering from severe obstructive CB. Conclusion. - Group 1 AB prescriptions were compliant with Anthonisen's criteria in most cases but the choice of AB did not follow French recommendations, with an over-prescription of group 2 AB and a bad assessment of simple CB. (C) 2004 Elsevier SAS. Tons droits reserves.