Antibiotics unnecessarily prescribed for acute bronchitis

New England Journal of Medicine article describes critical review of literature

Antibiotics are routinely prescribed unnecessarily for acute bronchitis, according to Virginia Commonwealth University findings published in today's issue of the New England Journal of Medicine.

Physicians for years have prescribed antibiotics for the treatment of acute bronchitis, a common condition caused by inflammation of the bronchi of the lungs that occurs in 5 percent of adults each year.

The VCU School of Medicine researchers concluded there is no evidence in current literature to support prescribing antibiotics for the treatment of short-term bronchitis as almost all the causes of such infections are viral and therefore don't respond to the therapy, according to the article.

Richard P. Wenzel, M.D., professor and chair in the Department of Internal Medicine at the VCU School of Medicine, and Alpha A. Fowler III, M.D., chair in the Division of Pulmonary Disease and Critical Care Medicine, conducted a critical review of the world literature. They examined research studies and clinical trials regarding acute bronchitis as they related to individuals, pathology, diagnosis, treatment strategies and any data supporting the potential benefits of anti-bacterial agents.

According to Wenzel, almost all the known causes of acute bronchitis are viral and are caused by organisms that have no known therapy and cannot be influenced by antibiotic treatment. Only a small percentage of acute bronchitis cases are caused by bacteria that physicians can treat, such as whooping cough. He said that approximately 70 percent to 80 percent of individuals are prescribed antibiotics for treatment lasting five to 10 days.

"As a community of medicine we have a habit of prescribing a lot of medication. There are many things we prescribe that are not based on evidence in the literature," Wenzel said. "Based on our review of the data in the literature, we are not practicing evidence-based medicine when it comes to the treatment of acute bronchitis."

In addition to little evidence supporting the effectiveness of antibiotics for the treatment of acute bronchitis, antibiotics can be expensive and may cause adverse side effects such as abdominal pain, diarrhea and rash that may require further treatment. Furthermore, induced resistance to antibiotics makes them less useful for treatment against other infections.

"There is a long history of patients receiving antibiotics for acute bronchitis and they have come to expect receiving a prescription for treatment. Physicians can help patients by not prescribing them antibiotics for acute bronchitis saving them from potential side effects and unnecessary costs," Wenzel said.

"Physicians should inform their patients that there are no data in the literature to support the use of antibiotics for this condition," he said.

Wenzel and Fowler also examined the literature to determine what other medications patients are frequently prescribed. They found that although prescription cough medications are prescribed in almost 100 percent of acute bronchitis cases, the literature showed little evidence of any effect.

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About VCU and the VCU Medical Center: Virginia Commonwealth University is the largest university in Virginia and ranks among the top 100 universities in the country in sponsored research. Located on two downtown campuses in Richmond, VCU enrolls more than 30,000 students in nearly 200 certificate and degree programs in the arts, sciences and humanities. Sixty-three of the programs are unique in Virginia, many of them crossing the disciplines of VCU's 15 schools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the nation's leading academic medical centers. For more, see www.vcu.edu.


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