More information on antibiotics for bronchitis

The evidence against using antibiotics to treat acute bronchitis continues to mount. Most recently, a study published in the October 4, 2013, BMJ looked at outcomes among patients treated with Augmentin, ibuprofen, or placebo. Not surprisingly, all three groups had coughing which lasted an average of nine days. Symptoms of all kinds continued for 10 days. In all three groups. There was no significant difference among the groups. Adverse effects were more common among the Augmentin-treated patients.

One wonders why studies like this continue to be performed and why respected medical journals continue to publish them, since the evidence is overwhelming already. At a certain point, the jury has spoken and there is no need to continue re-trying the case. The verdict has been reached and it is time to move on. But I suspect we’ll see more studies on this issue for years to come. Perhaps this is because physicians continue to prescribe antibiotics for acute bronchitis. Until this practice starts to wane, the papers will continue.

Now, while I could wrap things up at this point, I do want to say one more thing, which is that in writing this post, I feel like a sinner casting the first stone. Over the years, I have certainly prescribed my share of antibiotics for patients with acute bronchitis. While I can plead not-guilty for the first half of my career (before the evidence started to come in), I need to take the Fifth for the second half of my career. It’s been around 15-20 years that evidence has been mounting that antibiotics are not helpful in acute bronchitis and may be harmful. So why have you and I continued to prescribe these medications for this condition? There are several reasons. It takes less time to prescribe antibiotics than to take the time required to explain to patients why antibiotics are not helpful for their cough. Longer office visits are the last thing we need. Also, sometimes patients have been coughing for 3-4 weeks, or they look particularly sick, or they have underlying diabetes/lung disease/heart disease, and one does not want to risk something worse developing. And who among us has not had a patient develop a subsequent pneumonia after we declined their request for antibiotics a week earlier?

So, it is a tough and touchy issue. I will say that my antibiotic prescribing for acute bronchitis has gone down by a goodly amount compared to 10 or 15 years ago. And hopefully a similar approach is permeating the entire medical community. The better we do, the fewer studies we’ll need to read about the futility of antibiotics for many common conditions.

Richard Fleming, MD

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