A new study shows doctors have not stopped prescribing antibiotics for acute bronchitis, despite guidelines. / Joe Raedle, Getty Images
If you think you need an antibiotic for acute bronchitis, you are wrong, but you are not alone. Antibiotic prescription rates for adults with the common malady remain stubbornly in the 60% to 80% range, despite a long effort to get them down to zero, a new report says.
Acute bronchitis is a cough that lasts up to three weeks, often after a cold or flu. It is almost always caused by viruses. Antibiotics only treat bacteria, and cause more harm than good when used needlessly. They do nothing for coughs caused by viruses, no matter how hacking, mucus-filled or annoying those coughs may be, experts say.
"The awful truth of acute bronchitis is that the cough on average lasts for three weeks and it doesn't matter if you take an antibiotic or not," says Jeffrey Linder, a specialist in internal medicine at Brigham and Women's Hospital, Boston. He is co-author of a research letter published Tuesday in the medical journal JAMA.
The researchers reviewed records of 3,153 visits to doctors' offices and emergency rooms for acute bronchitis between 1996 and 2010. They included only adults who were otherwise healthy, not those with immune deficiencies, cancer, lung disease or other conditions that might complicate decision-making.
Result: An average of 71% got antibiotics and, after a possible dip in 1999-2001, the rate appeared to rise a bit over time. The numbers sampled in each time period were too small to produce firm year-by-year estimates, but the trend is clear, Linder says: "There's all this effort, but we're not moving the needle at all."
That failure reflects a larger problem, Linder and other researchers say: Patients keep demanding and doctors keep prescribing antibiotics for problems they can't cure. As a result, patients suffer unnecessary side effects, such as diarrhea and allergic reactions, and they play a part in the development and spread of germs that no longer respond to over-used antibiotics.
The good news is that for some illnesses, such as children's ear infections and sore throats, antibiotic prescribing rates are going down, Linder says.
The fact that the record for bronchitis is not as good is unfortunate because "bronchitis turns out to be the No. 1 reason doctors prescribe antibiotics to adults," says Ralph Gonzales, a professor of medicine at the University of California, San Francisco. Gonzales, who was not involved in the new research, says educating doctors and patients has proved difficult, despite campaigns by the federal Centers for Disease Control and Prevention and others.
For patients, he says, "there's a cultural belief," that bronchitis is curable with antibiotics. And bronchitis can be a frustrating illness, he says: "You can't suffer in silence because you are coughing all the time." Cough medicines and other treatments don't work particularly well, so stressed, busy adults are desperate to get relief and wrongly see antibiotics as a quick fix, he says.
Doctors, for their part, worry about missing pneumonia, which is sometimes treated with antibiotics, Gonzales says. But, he says, a careful exam can almost always rule it out in healthy people. That's why it's an especially bad idea, he says, to get antibiotics by phone.
So what can you do when you have bronchitis? According to the American Academy of Family Physicians, treatments for adults include:
â?¢ Rest, fluids and humidifiers
â?¢ Over-the-counter pain relievers
â?¢ Cough medicine (if cough is dry)
â?¢ Inhaled bronchodilators â?? medicines usually used for asthma â?? if you have wheezes along with coughs.
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