May 21, 2014
News Review From Harvard Medical School -- Most Still Get Antibiotics for Bronchitis
Antibiotics don't help infections, such as bronchitis, that are caused by viruses. But new research suggests that the public and doctors still have not embraced that message. In the study, 71% of patient visits for acute bronchitis led to an antibiotic prescription. The study covered the years 1996 through 2010. Bronchitis is an inflammation of the bronchial tubes in the lungs. It is almost always caused by a virus. The main symptom is coughing. "Acute" bronchitis means that symptoms have lasted less than 3 weeks. The study was published as a research letter in the journal JAMA. It was based on a national survey of doctors' offices and hospital emergency rooms. The sampling was selected to represent the United States as a whole. During the 15 years covered, these facilities reported 3,153 visits for acute bronchitis. The percentage of patients getting antibiotic prescriptions actually increased a bit during the study period. USA Today wrote about the study May 20.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Purists say that antibiotics should never be prescribed for acute bronchitis in otherwise healthy people. It's almost always caused by a virus. Antibiotics are useless against a viral infection.
It might not be correct to say that an antibiotic is never needed for acute bronchitis. But the percentage of healthy people needing an antibiotic should be close to zero. Antibiotics do not make bronchitis symptoms less severe or help them go away sooner. We know that based on strong evidence from many studies.
Major public health efforts have tried to make people aware of the need to reduce antibiotic use. Yet the results of this study show that we have made no progress in reducing the number of antibiotic prescriptions for acute bronchitis. In fact, the trend seems to be in the wrong direction for acute bronchitis. These researchers found that the chance of a person leaving the doctor's office or emergency room with an antibiotic prescription appears to be increasing.
Bronchitis is inflammation of the bronchial tubes (bronchi) that connect the windpipe (trachea) to the lungs. When people talk about having a chest cold, they're often talking about bronchitis.
The main symptom of bronchitis is coughing. And it can be bad. The cough may be a dry hack. But it may also produce phlegm (sputum), which can be clear, yellow or green. Wheezing and chest tightness sometimes occur if inflammation has narrowed the bronchi. Acute bronchitis means these symptoms have lasted three weeks or less.
So why do doctors still prescribe antibiotics for acute bronchitis? For decades, most patients and doctors believed that bronchitis had to be treated with an antibiotic. This perception has been hard to change.
The cough from bronchitis is a constant nuisance and an embarrassment. It can prevent you from getting a good night's sleep. Over-the-counter cough medicines don't do much. Even though the cough and other symptoms would last just as long with or without an antibiotic, patients remain convinced that an antibiotic gets them better faster.
Doctors often justify giving the antibiotic because they can't be sure that the symptoms are not an early indication of pneumonia. Pneumonia is treated with antibiotics.
What Changes Can I Make Now?
Some people do need an antibiotic to treat acute bronchitis. People with chronic obstructive pulmonary disease (COPD) are prone to bacterial bronchitis that can land them in the hospital. They should start an antibiotic if they have an increased cough with shortness of breath and if the sputum color changes to yellow or green.
But almost everyone else does not need an antibiotic. Your immune system will fight off the viral infection within a week. But the cough and wheeze can linger because your bronchial tubes are still inflamed.
To help ease the symptoms of acute bronchitis:
- Get warm, moist air into the bronchi. Take hot showers or use a humidifier.
- Get enough rest. You can still go to work or school. But schedule some down time for yourself every day and more time for sleep at night.
- Try an over-the-counter cough remedy. None of them is great, but you might find one that helps. It could be simple cough drops. Ask your pharmacist for advice.
- Consider asking your doctor for an inhaler to open the bronchi. It's similar to what people with asthma use. It can decrease the cough and wheeze.
Although the cough after bronchitis can last for three months, contact your doctor if the cough is not getting better after three weeks.
What Can I Expect Looking to the Future?
Many people realize that antibiotics are prescribed too often. But when you personally are sick with an illness such as bronchitis, it's hard to resist asking for an antibiotic. But you are actually doing yourself a favor if you don't. It won't help you, and you always run the risk of a major side effect, such as diarrhea that lasts for weeks or a rash that can be life-threatening.