Antibiotic and Bronchodilator Prescribing for Acute Bronchitis in the Emergency Department

Jason C. Kroening-Roche, MD; Arash Soroudi, MD; Edward M. Castillo, PHD, MPH; Gary M. Vilke, MD, FACEP, FAAEM

Disclosures

J Emerg Med. 2012;43(2):221-227. 

In This Article

Results

Of the 836 patients included in our study, 449 (53.7%) were women, and 499 (59.7%) were under the age of 50 years. Of the charts reviewed, 694 included information on tobacco use, 447 on alcohol use, and 484 on illicit drug use: 282 (40.6%) were identified as smokers on history, 87 (19.5%) reported alcohol use, and 39 (8.0%) used recreational drugs. Asthma was the most common comorbid condition (17.1%), with COPD (10.8%) and diabetes mellitus (7.9%) being the second and third most common, respectively. There were 56 (6.5%) patients recorded as having more than one comorbid condition. Table 1 provides patient demographics, and vital signs are displayed in Figure 1.

Figure 1.

Temperature data were not present in 11 patients, heart rate data in 15 patients, respiratory rate data in 14 patients, and systolic blood pressure data in 10 patients.

There were 552 (66%) patients who reported 7 or fewer days of cough, with only 50 (6%) reporting a cough of > 21 days duration before presentation. Of the charts reviewed, 48 reported no information on the duration of cough. Cough was the most common chief complaint (60%), with shortness of breath being the next most common (15.9%). A variety of complaints made up portions smaller than 1%, and was included in a category labeled "other," making up 10.8% of the total complaints.

Antibiotics were prescribed to 622 (74.0%) patients in this study. Among patients with comorbid conditions, antibiotics were prescribed to 81.1% with COPD, 76.2% with asthma, 86.7% with HIV/AIDS or those taking immunosuppressive medication, and 77.3% with diabetes mellitus. Antibiotics were prescribed to 74.1% of patients for whom >1 comorbid condition was reported ( Table 2 ). The three most common classes of antibiotics prescribed were macrolides (50.0%), tetracyclines (15.0%), and quinolones (6.7%). Of all the patients in the study, 480 (57.4%) received broad-spectrum antibiotics (defined as a macrolide, quinolone, cephalosporin, or Augmentin [GlaxoSmithKline, Brentford, Middlesex, UK]). In total, broad-spectrum antibiotics made up 77.2% of all antibiotics prescribed (Figure 2).

Figure 2.

Of patients prescribed antibiotics, macrolide antibiotics were prescribed to 66%, tetracyclines to 19.9%, quinolones to 9%, and penicillin to 2.7%. Overall, broad-spectrum antibiotics were prescribed to 77.2% of patients prescribed antibiotics.

Other treatments prescribed included inhaled bronchodilators in 400 (48%) patients, with 76 (9.1%) patients receiving an aerosol spacer device. Of those patients without asthma, 346 (49.9%) were discharged without a bronchodilator, and 631 (91.1%) were discharged without a spacer device. Again, in patients without asthma, 289 (41.7%) were prescribed antibiotics but no bronchodilator, compared to 124 (35.7%) who were prescribed a bronchodilator but not antibiotics. Patients with a historical finding of asthma were excluded from these calculations because they were likely to have a bronchodilator and spacer at home.

Patients 50 years of age and older were found to be 1.7 times more likely to be prescribed antibiotics than those under 50 years of age (95% CI 1.2–2.3, p = 0.002). Furthermore, smokers were 1.5 times more likely to be prescribed antibiotics than non-smokers (95% CI 1.0–2.2, p = 0.025), independent of age. No other statistically significant relationships were found relating the prescription of antibiotics to patient factors ( Table 3 , Table 4 , Table 5 ).

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