OBJECTIVES: Acute exacerbations of chronic bronchitis (AECB) are a leading cause of morbi-mortality and medical resources consumption. This study was aimed to estimate the economic and health consequences of first line antibiotics in the management of AECB and it´s recurrences, under the setting of a representative Mexican health care institution.  METHODS: Two models were developed: a decision tree for acute events (tree month horizon) and a two-state, one-quarter cycle Markov for recurrences (one year horizon). The competing alternatives (listed in the national formulary) were: moxifloxacin 400 mg/day, levofloxacin 500 mg/day, ceftriaxone 1000 mg/day, clarithromycin 1000 mg/day, cefuroxime 1000 mg/day and, not listed in the national formulary, gemifloxacin 320 mg/day. The clinical success rate and months free of recurrences (effectiveness measures) were extracted from international literature. Resource use was extracted from 117 clinical files (adult patients) treated at Instituto Mexicano del Seguro Social (IMSS).The cost of antibiotics were extracted from IMSS´s sources (except of gemifloxacin, provided by the manufacturer); the unit cost of physician visits, diagnostic tests, emergency room, in-patient, intensive care unit were the official for IMSS. Costs are expressed in 2012 U$. One-way sensitivity analysis was performed. RESULTS: The clinical success rates were between 97.5% (gemifloxacin) and 83.1% (cefuroxime), the costs per patient-per AECB were proportional: $3,375.6 (gemifloxacin) and $4825.1% (cefuroxime), gemifloxacin dominated progressively ceftriaxone, moxifloxacin, levofloxacin, clarithromycin and cefuroxime. Regarding AECB recurrences, clarithromycin represented the highest cost and lowest time free of recurrence: $8198.99 and 10.28 months, respectively, whereas gemifloxacin represented the opposite: $3,325.73 and 11.015 months, respectively. The length of stay were between 6.22 (gemifloxacin) and 10.3 days (cefuroxime). The results were robust to +10% acquisition cost, +5% adverse events incidence and -5% clinical success rate for gemifloxacin. CONCLUSIONS: At IMSS setting, gemifloxacin is an alternative that would promote savings in the treatment of AECB and it´s recurrences.