Antibiotics for Acute BronchitisAm Fam Physician. 2020 Nov 1;102(9):online.
ANTIBIOTICS FOR ACUTE BRONCHITIS OR ACUTE PRODUCTIVE COUGH
| Benefits | Harms |
|---|---|
No patients had clinical improvement in acute bronchitis during follow-up at two to 14 days | 1 in 24 developed gastrointestinal symptoms, headache, rash, or vaginitis |
1 in 6 had resolution of cough |
ANTIBIOTICS FOR ACUTE BRONCHITIS OR ACUTE PRODUCTIVE COUGH
| Benefits | Harms |
|---|---|
No patients had clinical improvement in acute bronchitis during follow-up at two to 14 days | 1 in 24 developed gastrointestinal symptoms, headache, rash, or vaginitis |
1 in 6 had resolution of cough |
Details for This Review
Study Population: Patients with acute bronchitis or acute productive cough with persistent cold or flulike illness
Efficacy End Points: Overall clinical improvement, patient-reported cough symptoms, feelings of illness, and limitations on activity, as assessed during follow-up at two to 14 days
Harm End Points: Adverse effects of antibiotic use (most commonly gastrointestinal symptoms), headache, skin rash, and vaginitis
Narrative: Acute bronchitis is a lower respiratory tract infection, most commonly viral, that accounts for a significant number of health care visits (100 million annually in the United States).1 It is characterized by acute onset and persistence of cough for one to three weeks. Reassurance and symptom control are the foundation of care for this self-limited condition; however, studies indicate that 50% to 90% of patients are prescribed antibiotics.2
The Cochrane review summarized here assessed the effect of antibiotics in patients with acute bronchitis.3 The review analyzed 17 randomized trials that compared any antibiotic therapy with placebo or with no treatment. The studies included 5,099 patients of either sex with acute bronchitis or cough, with persistent cold- or flulike illness, and who did not have preexisting pulmonary disease. Most trials excluded patients with clinical findings of pneumonia; four trials excluded patients based on radiographic findings. Eight of the studies enrolled adults, whereas the remainder included children and adolescents of varying ages. Antibiotics included dox
Copyright © 2020 MD Aware, LLC (theNNT.com). Used with permission.
This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.
A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.
References
1. Harris AM, Hicks LA, Qaseem A. Appropriate antibiotic use for acute respiratory tract infection in adults. Ann Intern Med. 2016;165(9):674.
2. Ebell MH, Radke T. Antibiotic use for viral acute respiratory tract infections remains common. Am J Manag Care. 2015;21(10):e567–e575.
3. Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017;(6):CD000245.
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