Appropriate antibiotic prescribing in bronchitis

Antibiotics are often inappropriately prescribed for adults with acute bronchitis. Clinical guidelines for treating adults with no co-morbidity do not indicate treatment with antibiotics. 

Acute bronchitis consistently ranks among the top 10 conditions diagnosed in the retail health setting. Most cases of bronchitis have a viral etiology — respiratory syncytial virus, adenovirus, influenza and parainfluenza being most common.  

Despite the fact that the vast majority of acute bronchitis cases (i.e., more than 90%) have a nonbacterial cause, antibiotics are prescribed 65% to 85% of the time. Inappropriate antibiotic treatment of adults with acute bronchitis is of clinical concern, especially since misuse and overuse of antibiotics lead to antibiotic drug resistance. Because so many of our patients come to us with symptoms related to bronchitis and other upper respiratory complaints, it is imperative that the retail clinician review and understand the Centers for Disease Control and Prevention guidelines on antibiotic use in upper
respiratory illnesses.

The evaluation of adults with an acute cough illness or with presumptive diagnosis of uncomplicated acute bronchitis should focus on ruling out pneumonia. In the healthy, non-elderly adult, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lung sounds. Routine antibiotic treatment of uncomplicated bronchitis is not recommended, regardless of duration of cough. Chronic bronchitis (i.e., cough with mucus most days for at least three months a year for at least two years) is more common among smokers.   

Patient education, while it sometimes presents difficulty, is of utmost importance. While patients are often eager for a quick fix, and clinicians are stressed for time in patient encounters, it is important to take a moment to explain to each patient the expected course of the illness (i.e., two to eight weeks) and provide empathy around the fact that although the patient is likely feeling quite ill, antibiotics will not alter the course of
the illness.


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