There is no debate regarding the correct treatment of acute bronchitis in patients without underlying immunodeficiency or pulmonary structural disease. The correct antibiotic treatment is: none. This is not a controversial subject. Indeed, as this research letter in JAMA notes, since 2005 the National Committee of Quality Assurance has published a measure in the Healthcare Effectiveness Data and Information Set stating the correct rate of antibiotic prescribing in acute bronchitis is: zero.
If you’re hoping this next part is where I excitedly share a successful reduction in inappropriate antibiotic use, you’ll be more than a little disappointed.
Using The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, these authors found, unfortunately, that 71% of patients with acute bronchitis are receiving a prescription for antibiotics in outpatient settings. There was essentially no difference in prescribing rates over any of the NAMCS samples – we were just as irresponsible in the 2008-2010 survey period as we were in the 1996-1998 period. There was no difference in rate between Emergency Department and primary care settings, nor in race, age, insurance status, nor care location. 41% of patients received an extended macrolide – azithromycin – followed most commonly by fluroquinolones, aminopenicillins, and cephalosporins.
Yes, Virginia, a self-limited condition for which antibiotics confer no benefit frequently receives fluoroquinolone therapy.
Words fail me. I will simply quote the authors’ conclusion:
“Avoidance of antibiotic overuse for acute bronchitis should be a cornerstone of quality health care. Antibiotic overuse for acute bronchitis is straightforward to measure. Physicians, health systems, payers, and patients should collaborate to create more accountability and decrease antibiotic overuse.”
“Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010”
http://jama.jamanetwork.com/article.aspx?articleid=1872806