Wednesday, January 10, 2007

Bronchitis and Antibiotics

Bronchitis and Antibiotics

Antibiotics Are Useless for Most Cases of BronchitisBut doctors keep prescribing them, contributing to bacterial resistance, study says


Most people who go to a doctor with the raspy breathing problem called bronchitis get an antibiotic. Most of them shouldn't, a new study contends.

Two physicians at the Virginia Commonwealth University School of Medicine surveyed the world literature on bronchitis -- research studies, clinical trials and anything related to bronchitis and its treatment.

"Physicians should be encouraged to avoid antibiotics in most cases," said Dr. Richard P. Wenzel, chairman of the department of internal medicine at Virginia Commonwealth and one of the authors of the report.

The findings are published in the Nov. 16 issue of the New England Journal of Medicine.
The primary reason for over-prescription of antibiotics is that most cases of bronchitis, which is inflammation of the tiny airways of the lungs, "are caused by agents for which we have no therapy yet," meaning viruses, Wenzel said. Only a small percentage of acute bronchitis cases are caused by bacteria that doctors can treat, such as whooping cough, he said.

Yet doctors keep prescribing antibiotics, he said. He estimated that 70 percent to 80 percent of bronchitis patients are given a course of antibiotics lasting five to 10 days.

That's a lot of antibiotics. One of every 20 American adults will get bronchitis in a given year, Wenzel said. A first reason for them not taking antibiotics is that the drugs cost money, in an era when the mounting cost of health care is a major concern, he said.

"And all antibiotics have side effects, such as rash, diarrhea and abdominal pain," Wenzel said. Side effects are acceptable only when a medication helps the patient, he said.

"The third reason for not prescribing antibiotics is the impressive pressure it puts on organisms to select more resistant strains, so that the ones we use will no longer be effective," Wenzel said. While economists worry about medical costs, physicians worry about antibiotic-resistant strains of bacteria.

With all those arguments against the practice, why do doctors still write those prescriptions?
One reason is convenience, Wenzel said. "Think of all the patients we have to move through the office," he said. "I could take 15 minutes to explain why an antibiotic is not needed or write a prescription in 30 seconds."

And bronchitis tends to be overlooked as a subject of medical interest, Wenzel said. "It isn't considered very jazzy," he said. "It doesn't get highlights in medical journals or educational conferences. I can't remember in the past 10 years hearing a speaker discuss bronchitis at a medical meeting."

The information on bronchitis is there for any doctor who cares to look. The American Academy of Family Physicians notes that "because acute bronchitis is usually caused by viruses, antibiotics... usually do not help." The academy recommends getting lots of rest, drinking lots of non-caffeinated fluids, keeping the indoor humidity high and waiting for the condition to go away "after a few days or a week." If coughing and other symptoms persist, it could be a sign of a more serious condition, such as asthma or pneumonia.

One big reason for antibiotic prescriptions is patient demand, said Dr. Jeffrey Chapman, director of interstitial lung disease at the Cleveland Clinic.

"But patients are getting more savvy," he said. "They understand that a lot of infections are viral and that giving them an antibiotic places them at risk."

People with the bothersome symptoms of bronchitis shouldn't insist on a prescription, Chapman said. They should understand that "it may be the best course of treatment not to give an antibiotic."

"The message is getting out, a little bit at a time," he said. "There is a better understanding than there was, say, 10 years ago, that sometimes an antibiotic is not the better treatment."