Editorial Commentary: Who Should Receive Antibiotics for Exacerbations of Chronic Bronchitis? A Plea for More Outcome‐Based Studies

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Abstract
For many years, there has been controversy about whether bacteria play a role in acute exacerbations of chronic bronchitis (AECB) and, thus, whether antibiotics have a role in disease management [1]. Many experts have recognized that there is widespread use of antibiotics in this population and have considered such therapy to often be unnecessary, arguing that the use of antibiotics adds to the problem of antimicrobial resistance [1–3]. This is an important concern, because most studies have shown that the repeated use of antibiotics in patients with chronic obstructive pulmonary disease (COPD) can lead to the emergence of drug-resistant pneumococci. In a recent consensus conference, the American College of Physicians (ACP)/American Society of Internal Medicine (ASIM)/American College of Chest Physicians (ACCP) stated that antibiotics have a limited role for treatment of this illness and should only be used by patients with severe exacerbations [2, 3]. In the current issue of Clinical Infectious Diseases, van der Valk et al. [4] have tried to identify clinical predictors of bacterial exacerbation of COPD in an effort to promote more judicious use of antibiotics. This may be a valuable goal, because they conclude that 38% of patients with nonbacterial exacerbation of COPD received antibiotics, whereas 36% of those with a documented bacterial infection did not receive antibiotic therapy.