Docs continue to prescribe antibiotics for acute bronchitis

By Megan Brooks

NEW YORK (Reuters Health) - Antibiotics continue to be prescribed for most Americans with acute bronchitis, despite unequivocal evidence that they aren't effective, as well as guidelines and years of educational efforts to curb the practice, a new study shows.

"I was really disappointed in these data. Despite all the efforts that the CDC and specialty societies have done, we really haven't moved the needle too much on the antibiotic prescribing rate for acute bronchitis," Dr. Jeffrey Linder, of Brigham and Women's Hospital in Boston, Massachusetts, noted in an interview with Reuters Health.

"I like to hope that most doctors know they aren't supposed to prescribe antibiotics for acute bronchitis but I think some doctors might be responding to perceived patient demand and the desire to do something for their patients. For whatever reason, acute bronchitis remains in the public consciousness that is something that gets treated with antibiotics, despite all the data showing that antibiotics don't help at all," Dr. Linder said.

Despite more than four decades of research showing antibiotics are not effective for acute bronchitis, between 1980 and 1999, the rate of antibiotic prescribing for acute bronchitis was between 60% and 80% in the United States.

Since 2005, a Healthcare Effectiveness Data and Information Set (HEDIS) measure has said that the antibiotic prescribing rate for acute bronchitis should be zero. But the US is not even close to that goal, Dr. Linder and co-author Dr. Michael Barnett report in the May 21 issue of JAMA.

They evaluated the change in antibiotic prescribing rates for acute bronchitis in the US between 1996 and 2010 using data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

Among 3,153 sampled acute bronchitis visits between 1996 and 2010 that met study inclusion criteria, the overall antibiotic prescription rate was 71% and rose during the study period. There was a significant increase in antibiotic prescribing in emergency departments.

Doctors prescribed extended macrolide antibiotics at 36% of acute bronchitis visits, and extended macrolide prescribing increased from 25% of visits between 1996 and 1998 to 41% between 2008 and 2010. Other antibiotics were prescribed at 35% of visits, most commonly fluoroquinolones, aminopenicillins and cephalosporins.

Dr. Linder admits pressure from patients who think they need an antibiotic is real. "I feel it. When patients take time off from work, it's a little unsatisfying to say you have a cough that is going to last for three weeks and I have nothing available that is going to change that. That's the reality. The main thing I try to get across to patients is, as long as you are feeling better and your cough is slowly, slowly going away, that's how acute bronchitis works and antibiotics won't change it," he told Reuters Health.

In a telephone interview with Reuters Health, Dr. David Fleming, President of the American College of Physicians and Chairman of the Department of Internal Medicine at University of Missouri School of Medicine, said, "We've known for along time that antibiotics aren't helpful for upper respiratory infections including acute bronchitis. The problem is that the prescribing habits of physicians and the prescription-seeking habits of patients remain the same."

Dr. Fleming added, "If you spend time with the patient, if you have a good relationship with your patient and communicate well and give them the information, most of the time they will understand; reassure them that, if they don't get better, they need to come back for another assessment and if there is clear clinical evidence to suggest that antibiotics might be of help then an antibiotic may be prescribed at that time."

In their article, Dr. Linder and Dr. Barnett suggest physicians, health systems, payers, and patients "collaborate to create more accountability and decrease antibiotic overuse."


JAMA 2014;311:2020-2021.

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