Chronic bronchitis and its complications is one of the most common causes of visits to physicians. Prevention of both disease progression and infectious exacerbations lies mainly with smoking cessation and vaccination strategies. Medical therapy of the disease may improve symptoms but has not been shown to alter the natural history. Bacterial pathogens account for the majority of infectious flares of the disease but the presence of chronic airway colonization makes it difficult to separate pathogens from commensal organisms. The choice of antimicrobial therapy to treat infectious exacerbations should be based on a combination of patient's age, severity of underlying airflow obstruction, frequency of exacerbations and the presence of other underlying diseases which increase the risk of treatment failure.