News Review From Harvard Medical School -- Reducing Antibiotic Use for Bronchitis
With reminders, doctors may prescribe fewer antibiotics for bronchitis, a study finds. Antibiotics kill bacteria. They won't help bronchitis, which is caused by a virus. But doctors prescribe antibiotics for 70% of U.S. patients with bronchitis. The new study included 33 medical offices. They were randomly divided into 3 groups. One group received posters that pointed out when antibiotics should and should not be used. The second group received advice through the office's electronic records system. The third group did not get either form of decision support. The study lasted 6 months, October through March. Researchers kept track of antibiotic prescriptions for bronchitis during the study period. They compared this to the same period in the last 3 years. In the offices that got the posters, prescriptions dropped from 80% of bronchitis cases to 60.7%. They fell from 74.0% to 60.7% in the group with electronic support. They went up slightly in the third group. The journal JAMA Internal Medicine published the study January 15.
By Lori Wiviott Tishler, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
This doctor's practice, like all other primary care practices, is seeing a lot of people with coughs right now. Some people have colds. Some people have bronchitis. Some -- right now, many -- have the flu. Very few people have infections caused by bacteria, such as acute sinusitis or pneumonia.
Many doctors would like to be able to prescribe an antibiotic to fix people's symptoms. Patients would like to take a few pills and have their symptoms magically disappear. Doctors would like to be able to give patients what they want. Unfortunately, with acute bronchitis, antibiotics just don't work!
Acute bronchitis is a very common respiratory illness. The symptoms include cough, phlegm and sometimes a bit of wheezing.
Fifteen studies have shown that antibiotics don't help people with acute bronchitis. People are more likely to have a side effect from the antibiotic than to be helped by one in this setting! These statistics are mentioned in a commentary published along with a new study on treatment of acute bronchitis. The commentary author, Jeffrey Linder, M.D., M.P.H., is one of my practice partners.
This new study sought to decrease antibiotic prescribing for acute bronchitis. Currently, more than 70% of U.S. patients with acute bronchitis leave their doctor's office with a prescription for an antibiotic.
In the study, doctors were given information about the reasons not to prescribe antibiotics for acute bronchitis. They received the information either on paper (a poster for their offices) or via decision support in their medical record system. All of the doctors were part of a large health care system in central Pennsylvania.
Researchers found that both of the reminder systems helped decrease inappropriate prescriptions by more than 10%. This is certainly good news. But, as the commentary says, going from 70% to 60% is a mere drop in the bucket. The number should be close to zero!
It's also really important to note that, as antibiotic prescriptions dropped, the risk of pneumonia stayed the same! People did not get sicker in large numbers if they did not receive an antibiotic.
What Changes Can I Make Now?
For prevention of respiratory illness, you should have a flu shot. The supply is good nationwide and the risks are low. A flu shot can make a huge difference to your health and the health of your family.
People at high risk for pneumonia should get a pneumonia shot as well. Flu shots are seasonal, but pneumonia shots can be protective year-round. Ask your doctor or caregiver if this shot is a good idea for you.
If you have a cough with phlegm and maybe a few wheezes, you might have bronchitis. Here are some suggestions:
- If you see your doctor, don't be disappointed if you don't get an antibiotic. Be open to other options for treatment.
- Drink lots of fluids.
- You might consider a cough suppressant if you find that it helps. Ask your doctor or pharmacist which ones might help you.
- Be patient. You'll get better. It will just take more time than either you or your doctor would like!
- Rarely, your doctor might prescribe something for wheezing.
What Can I Expect Looking to the Future?
All doctors and patients want to get the best and most correct care. I expect we will see more studies in this vein, which try to help providers give the best care to patients. I hope that we will also see more educated patients who are willing to learn and understand which treatments make the most sense.