'I Need Antibiotics for My Bronchitis,' Your Patient Insists

Charles P. Vega, MD


February 23, 2023

A man who looks older than his 43 years walks into the clinic. A cigarette smoker, he made a same-day appointment because of a 5-day history of cough. The cough was initially dry and mild, but upon awakening, it had become wet, with green phlegm. He has mild nasal congestion without any facial pain or pressure, but no dyspnea. He denies fever or myalgia but is fatigued because the cough keeps him up at night. He has no known sick contacts.

Two home antigen tests for SARS-CoV-2 have been negative, and he has not received COVID-19 or influenza vaccines. He has smoked about one pack of cigarettes per month over the past 20 years and has no known lung disease. Physical exam demonstrates normal vital signs and mild clear drainage in the nares, along with reticular erythema in the posterior oropharynx without exudate. His lungs are clear to auscultation.

You discuss your differential diagnosis with the patient. He tells you, "Whatever. I need to get over this bronchitis, like, yesterday. I have a huge meeting with clients this weekend and need to be on top of my game. I get bronchitis every winter and get an antibiotic, and it goes away. So please help me out."


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