Antibiotics of Little Benefit for Bronchitis

NEW YORK (Reuters Health) - People with acute uncomplicated lower respiratory tract infection who are prescribed antibiotics get better only slightly faster than similar patients who are not given antibiotics, according to a report in this week's issue of the Journal of the American Medical Association.

Also, people appear to accept not getting antibiotics for bronchitis, as long as their doctors reassure them and explain their decision to withhold antibiotics.

"It is difficult to justify widespread antibiotic prescribing for uncomplicated lower respiratory tract infection on this basis given the dangers of antibiotic resistance," Dr. Paul Little and colleagues conclude.

Little, of the University of Southampton, England, and his associates recruited patients with cough and one other lower respiratory tract symptoms such as sputum, chest pain, breathlessness or wheeze.

A total of 807 patients were randomly assigned to immediate antibiotics, no antibiotics, or delayed antibiotics to be used if symptoms did not resolve.

Daily symptom diaries were returned by 562 patients after 3 weeks, and another 78 patients provided information about symptom duration and severity.

Antibiotic treatment had no effect on overall duration of cough, although immediate prescription of the drugs reduced duration of moderately bad symptoms by approximately 1 day.

Only one patient developed pneumonia requiring hospitalization.

The team found that more patients (86 percent) in the immediate antibiotic group reported being 'very satisfied', compared with 77 percent in the delayed group and 72 percent in the no-antibiotic group. However, fewer of these patients believed the antibiotics were effective.

In an accompanying editorial, Dr. Mark H. Ebell comments that "by prescribing antibiotics it is clear that clinicians are training patients to expect these drugs."

Ebell, from Michigan State University in Lansing, recommends that "physicians who feel compelled to give an antibiotic should at least use the tactic of delayed prescriptions to mitigate the effects of this prescribing error."

SOURCE: Journal of the American Medical Association, June 22/29, 2005.