Drug treatment ineffective for acute bronchitis

Oct 14 2013

A study published in the BMJ indicates that neither oral antibiotics nor nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than placebo for the treatment of acute bronchitis.

“Most of these infections are self limiting, and several studies have suggested that the benefit of antimicrobial treatment is marginal. However, most patients with acute bronchitis receive antibiotics, even in countries with low rates of antibiotic prescribing,” say authors Carl Llor (Cardiff University, UK) and colleagues.

“This over-prescription constitutes a global problem and is an important factor in increasing the levels of antibiotic resistance.”

The study involved 416 patients presenting to their general practitioner with cough, discolored sputum, and at least one other criterion for lower respiratory tract infection: dyspnea, wheezing, chest discomfort, or chest pain.

They were randomly assigned to receive an NSAID (n=136), an antibiotic (n=137) or placebo (n=143) for 10 days, and completed a symptom diary assessing disease severity, daytime cough, nighttime cough, limitation in daily activities, and febrile sensation for a maximum of 30 days.

The researchers found that there was no significant difference in the median number of days with frequent cough between the groups, at 9, 11, and 11 days, respectively. And neither active treatment was associated with an increased likelihood for cough resolution compared with placebo, including after adjustment for confounders.

Furthermore, patients in the antibiotic group were significantly more likely to report adverse events than patients in the ibuprofen or placebo groups (12 vs 5 and 3%, respectively).

Llor et al say that while previous research supports the efficacy of antibiotic treatment for purulent exacerbations of chronic obstructive pulmonary disease, their findings show that this “cannot be extrapolated to people with milder acute bronchitis without underlying pulmonary disease, even if they produce discoloured sputum.”

They add that the results support previous negative findings into the impact of antibiotics on acute cough duration, and add to scant data on a role for NSAIDs in acute respiratory tract infection.

“These findings have important implications for the daily clinical practice of doctors,” the team concludes.

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