Thursday, December 9, 2010

Antibiotics for acute bronchitis: just don't do it

In 1998, AFP published an article on acute bronchitis that pointed out the discrepancy between usual practice and evidence demonstrating the lack of effectiveness of prescribing antibiotics for this condition:

Although many authorities have argued that antibiotics have no role in the treatment of acute bronchitis, these agents remain the predominant therapy offered to patients. Primary care physicians in the United States have treated acute bronchitis with a wide range of antibiotics even though scant evidence exists that antibiotics offer any significant advantage over placebo.

Twelve years later, it appears that little has changed. According to an updated review of the diagnosis and treatment of acute bronchitis by Ross Albert, MD, PhD in AFP's December 1st issue,

Because of the risk of antibiotic resistance and of Clostridium difficile infection in the community, antibiotics should not be routinely used in the treatment of acute bronchitis, especially in younger patients in whom pertussis is not suspected. Although 90 percent of bronchitis infections are caused by viruses, approximately two thirds of patients in the United States diagnosed with the disease are treated with antibiotics. ... Clinical data support that antibiotics do not significantly change the course of acute bronchitis, and may provide only minimal benefit compared with the risk of antibiotic use itself.

If the evidence has been this clear for so long, why do family physicians continue to prescribe antibiotics for patients with acute bronchitis? The usual explanations are that 1) patients expect to receive antibiotics; and 2) prescribing an antibiotic takes less time than talking the patient out of the prescription. However, Dr. Albert's article also observes that "studies have shown that the duration of office visits for acute respiratory infection is unchanged or only one minute longer when antibiotics are not prescribed." To help AFP's readers better manage patients' expectations, the article contains a handy table of communication strategies that clinicians can use to avoid unnecessary and potentially harmful antibiotic prescriptions.

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