Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is characterized by excessive bronchial mucus secretion and a productive cough that usually lasts three months or longer in two consecutive years. Abnormalities associated with chronic bronchitis are thickened bronchial walls, mucosal inflammation in the walls and airways, and hypertrophied and hyperplastic mucus glands (Arcangelo & Peterson, 2013).
The recommended drug treatment for controlling chronic bronchitis is divided into three lines (Arcangelo & Peterson, 2013). First, aminopenicilins, such as ampicillin and amoxicillin, are usually sufficient for simple chronic bronchitis cases. Second, in complicated chronic bronchitis, second-generation or third-generation cephalosporin, macrolide antibiotics, penicillin plus beta-lactamase inhibitor, or fluoroquinolones should be used. Third, for patients with chronic bronchitis infections, fluoroquinolones are the most reliable choice.
Before initiating treatment, it is important to consider the gender of the patient because some of those drugs were associated with adverse events in women. For example, doxycycline and fluoroquinolones, which are sometimes used in the second line of treatment, are pregnancy category D and category C drugs. They should not be prescribed to pregnant and lactating women, but fluoroquinolones can be prescribed if the benefits are higher than the risks, such as in chronic bronchitis infection patients (Arcangelo & Peterson, 2013). In the second line of treatment, cephalosporin is a safer alternative in pregnant women.
In the first line of treatment, amoxicillin and ampicillin are both category B drugs, but the lack of controlled data on human pregnancy indicates that caution is required when treating pregnant women (Cerner Multum, 2010a; Cerner Multum, 2010b). Furthermore, both amoxicillin and ampicillin in women have been associated with secondary symptoms, such as vaginitis, so it is possible that additional treatments will be required (Arcangelo & Peterson, 2013). Finally, ampicillin can reduce the effectiveness of birth control pills (Cerner Multum, 2010b), so amoxicillin may be a safer option for women who take birth control. There are no better alternatives in the first line of treatment for chronic bronchitis, so adjusting dosage and monitoring response to treatment should be implemented in female patients.
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Cerner Multum. (2010a). Amoxicillin. Retrieved from http://www.drugs.com/amoxicillin.html
Cerner Multum. (2010b). Ampicilin. Retrieved from http://www.drugs.com/mtm/ampicillin.html
