[Update on the use of levofloxacin in the management of acute exacerbations of chronic bronchitis with risk factors].

INDICATIONS FOR ANTIBIOTICS: In patients with acute exacerbation of chronic bronchitis depend on the stage of the chronic disease. Theoretically, antibiotics are not necessary for acute exacerbation of simple chronic bronchitis, but may be needed to reinforce bronchodilatation therapy and respiratory physical therapy. If fever persists for more than three days, group 1 antibiotics can be prescribed. In a second stage (obstructive chronic bronchitis), antibiotic therapy can be useful for patients with two or three Anthonisen criteria: group 1 antibiotics for occasional exacerbation, group 2 antibiotics in case of failure or as first line treatment for patients with frequent exacerbations; anti-pneumococcal fluoroquinolones are a possible alternative. At a third stage (chronic respiratory failure), first line therapy should include group 2 antibiotics. THE BRONCHEA STUDY: Was designed to search for risk factors favoring frequent acute exacerbation of chronic bronchitis in adults. The findings suggest that certain classical risk factors such as age should be revisited. This study demonstrated the crucial need for rigorous surveillance by a lung specialist, the importance of not smoking, and the beneficial effect of optimized treatment. It was also found that earlier initiation of group 2 antibiotic therapy may be useful for patients with a high risk of exacerbation.