Source: Smith S. Antibiotics for acute bronchitis. JAMA 2014;312:2678-2679. 

The scenario is commonplace, evokes sympathy, and might even make you feel a little uncomfortable: Your third patient of the morning comes in with an apparent viral bronchitis, with the chief complaint, “I need some antibiotics.” While an antibiotic prescription might seem to be the path of least resistance, the literature does not provide support that it is the wisest path.

Most cases of acute bronchitis in healthy individuals are viral. A review of seven randomized trials found that antibiotic treatment provided a short-term benefit of a half-day shorter duration of cough than placebo. This modest benefit needs to be weighed in comparison to the many adverse effects associated with antibiotic administration. Concordant with these observations, the National Institute for Care Excellence (United Kingdom) Guidelines have suggested that antibiotics not be used for healthy persons in the absence of pneumonia.

While some patients will be disappointed if antibiotics are not dispensed, an explanation of the risk:benefit ratio will often assuage them. Despite increasing awareness of the limited benefits of antibiotics, over-prescribing remains common-place.