Antibiotics: Not for Acute Bronchitis

In otherwise healthy individuals, acute bronchitis (AB) is most often of viral etiology and runs a self-limited course. Despite growing concern about bacterial antibiotic resistance, published demonstration of scant benefit produced by antibiotic treatment of AB in individual trials, and literature reviews suggesting little overall favorable impact of antibiotics on AB, physicians continue to commonly employ them.

Hueston examined three strategies: 1) Antibiotics are prescribed only after AB cough has persisted more than 30 days (at which time persistent cough is felt to be more likely bacterial in origin); 2) all AB patients receive an immediate high-sensitivity test for M. pneumoniae or C. pneumoniae, and, if positive, they are treated; 3) all AB patients are treated with antibiotics. Cost considerations were based upon a $38 office visit charge, $11 for seven days of erythromycin, $33 for five days of azithromycin, and $23 for a rapid Chlamydia/Mycoplasma test (based upon the comparable charge for currently available rapid Strep tests).

Using antibiotics only for persistent (> 30 days) cough emerged as the most cost-effective method, saving about $7 per patient compared with treating all patients, and $18 savings over universal Chlamydia/Mycoplasma screening.

The author acknowledges that although holding therapy until cough is persistent is the least costly, there may be some patients for whom the more expensive options may be a reasonable trade-off, on the theoretical basis they may experience more rapid improvement.

Hueston WJ. J Fam Pract 1997;44: 261-265.