Letters to the Editor

Use of Antibiotics in Patients with Acute Bronchitis



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Am Fam Physician. 1998 Oct 15;58(6):1303-1304.

to the editor: After reading the article “Acute Bronchitis” by Drs. Hueston and Mainous,1 I have as many new questions as questions that were answered by the article. I think the authors wrote an informative review of the pathophysiology, epidemiology and etiologic agents of bronchitis. However, I wonder how a practicing family physician might approach the disease given this information.

The authors state that only about 5 percent of cases of bronchitis are bacterial in origin. They also point out that production of sputum is a poor diagnostic clue and that physical examination is unreliable in diagnosing the disease. They cite numerous studies showing that the use of antibiotics has no increased benefit over the use of placebo. Finally, they quote studies that demonstrate benefit from the use of bronchodilators in adults with bronchitis.

I would be interested to know how, in the authors' opinion, a physician might approach a patient who falls into the general category of “acute bronchitis.” Do the authors feel that antibiotics should never be used, or do they think they should only be used in certain groups of patients? If patients with bronchitis caused by Chlamydia infection are at increased risk of developing asthma, wouldn't it be important to treat those patients? Is it possible (and cost effective) to stratify a patient's risk for bronchitis caused by Chlamydia? If antibiotics are to be used selectively, what criteria should one use to identify patients who would benefit? Last, do the authors recommend a trial use of bronchodilators in every patient with bronchitis or only in those who have clinical signs and symptoms of bronchial obstruction?

As a family physician caring for patients on a daily basis, I want to treat disease in a reasonable, safe, effective and cost-efficient manner. I would appreciate the authors' advice on how best to do that when faced with the very common clinical picture of acute bronchitis.

REFERENCE

1. Hueston WJ, Mainous AG III. Acute bronchitis. Am Fam Physician. 1998;57:1270–6.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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