Anthony Miller, a 59-year-old male, presents to the clinic with complaints of cough, shortness of breath, and increased sputum production. His past medical history is significant for COPD with chronic bronchitis, hypertension, diabetes, and hyperlipidemia. He reports that his sputum has increased in consistency and amount over the past few days. His last exacerbation was about 6 months ago, for which he received amoxicillin. This is his third exacerbation in the past year. He has a 40-pack year history of cigarette smoking and quit smoking 3 years ago. He does not take chronic steroids. Physical exam reveals rhonchi and expiratory wheezes. His vital signs are blood pressure 140/83 mm Hg, pulse rate 80 beats/min, respiration rate 20 breaths/min, and temperature 98.8® He has no known drug allergies. A sputum Gram stain in the office reveals purulent sputum (presence of WBCs). Chest x-ray findings are negative for pneumonia.

Diagnosis: Acute Exacerbation of Chronic Bronchitis,ease provide your rationales for each answer with supporting data

Which of the following would suggest the need for antibiotic therapy in A.M.?

Cough, history of smoking, and expiratory wheezes on physical examination

Elevated respiratory rate and shortness of breath

1. Increased dyspnea, increased sputum production, and increased sputum purulence

History of previous COPD exacerbations, cough, and fever 

1. What is a likely pathogen associated with an acute exacerbation of chronic bronchitis in A.M.? 
2. Mycobacterium tuberculosis
3. Pseudomonas aeruginosa
4. Staphylococcus aureus
5. Streptococcus pneumonia

What antibiotic would be most appropriate to treat an acute exacerbation of chronic bronchitis in A.M.? 

1. Amoxicillinìavulanate
2. Azithromycin
3. Linezolid
4. Sulfamethoxazole/trimethoprim
5. What is the mechanism of action of the medication of choice in question #3? Provide rationale.

What kind of counseling points would you provide for A.M.?