Antibiotic Scripts for Bronchitis Common Despite Guidelines

Marcia Frellick

May 21, 2014

Physicians are prescribing antibiotics for acute bronchitis at rates between 60% and 80%, despite guidelines and educational efforts that say the rate should be zero, according to a research letter published in the May 21 issue of JAMA.

For more than 40 years, the authors note, clinical trials have shown that antibiotics are ineffective in treating acute bronchitis, a respiratory illness with a typical duration of less than 3 weeks. The Centers for Disease Control and Prevention says acute bronchitis is almost always caused by a virus, so antibiotics will not help. Taking antibiotics when they are not needed can also be harmful and can lead to diarrhea, rashes, and stomach distress.

Michael L. Barnett, MD, and Jeffrey A. Linder, MD, MPH, from Brigham and Women's Hospital, Boston, Massachusetts, studied initial visits made by adults aged 18 to 64 years to primary care physicians, general medicine clinics, or emergency departments between 1996 and 2010 with any diagnosis of acute bronchitis. They did not include those admitted to the hospital or visits associated with chronic pulmonary disease, immunodeficiency, cancer, or concomitant infectious diagnoses.

Numbers used in the study came from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), which are annual, nationally representative probability surveys of US ambulatory care.

Overall, there were 3153 visits that met the study criteria. The investigators found that the overall prescription rate was 71% (95% confidence interval [CI], 66% - 76%) and had increased during that time (adjusted odds ratio per 10-year period, 1.75; 95% CI, 1.06 - 2.90; P = .03).

Prescriptions for 1 type of antibiotic, macrolide, spiked from 25% of visits in 1996 to 1998 to 41% in 2008 to 2010 (P = .01). Other antibiotics were prescribed at 35% (95% CI, 30% - 39%) of visits.

For 15 years, the CDC has urged providers to stop prescribing antibiotics for acute bronchitis. Since 2005, a Healthcare Effectiveness Data and Information Set measure has stated that the prescribing rate should be zero, the authors say.

Dr. Barnett and Dr. Linder included limitations in the study, such as that the sample size for some estimates was small and that the surveys do not capture care provided outside of clinic visits.

However, they said, antibiotic use is easily measured and controlled.

"Avoidance of antibiotic overuse for acute bronchitis should be a cornerstone of quality health care.... Physicians, health systems, payers, and patients should collaborate to create more accountability and decrease antibiotic overuse," they conclude.

Support was received from the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, and the Agency for Healthcare Research and Quality. Dr. Barnett has reported serving as a medical adviser to Ginger.io, which has no relationship to this research. The other authors have disclosed no relevant financial relationships.

JAMA. 2014;311:2020-2022. Extract

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