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Antibiotics for acute bronchitisSmith SM, Fahey T, Smucny J, Becker LA
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SummaryDo benefits or harms result from the prescribing of antibiotics for bronchitis?Acute bronchitis is one of the most common illnesses and may be caused by either viral or bacterial infection. In healthy communities, there is little evidence of bacterial infection in people with bronchitis, but there is no practical test to distinguish between bacterial and viral bronchitis. Within this context the use of antibiotics to treat acute bronchitis is controversial but common. This review found that some people treated with antibiotics recovered a bit more quickly. However, these benefits need to be considered in the context of the potential side effects and costs of antibiotic use, such as increasing resistance of organisms to antibiotics.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 20. 1997 AbstractBackgroundThe benefits and risks of antibiotic treatment of acute bronchitis remain unclear even though it is one of the most common illnesses seen in primary care. Many clinicians prescribe antibiotics in spite of expert recommendations against this practice. ObjectivesThe objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis. Search strategyIn this updated review, we searched the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2007, issue 4); MEDLINE (1966 to December 2007); and EMBASE (1974 to December 2007). Selection criteriaRandomized controlled trials (RCTs) comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, without other obvious cause, in patients without underlying pulmonary disease. Data collection and analysisAt least two review authors extracted data and assessed trial quality. We contacted trial authors for missing data. Main resultsFourteen trials involving over 1500 patients and including smokers and non-smokers were identified and included in the primary analysis. The quality of the trials was variable. Overall, patients receiving antibiotics had better outcomes than those receiving placebo. At follow up, patients given antibiotics were less likely to have a cough (risk ratio (RR) 0.64, 95% CI 0.49 to 0.85; number needed to treat (NNT) 6); have a night cough (RR 0.67, 95% CI 0.54 to 0.83, NNT 7); not improve according to the clinician's global assessment (RR 0.44, 95% CI 0.30 to 0.65, NNT 14); and have an abnormal lung exam (RR 0.54, 95% CI 0.41 to 0.70, NNT 6). Antibiotic-treated patients also had a reduction in days feeling ill (0.64 days, 95% CI 0.13 to1.16) and a reduction in days with limited activity (0.49, 95% CI 0.04 to 0.94). The differences in presence of a productive cough at follow up; proportions with activity limitations at follow up; mean duration of cough and mean duration of productive cough did not reach statistical significance. There was a non-significant trend toward an increase in adverse effects in the antibiotic group (RR 1.15, 95% CI 0.92 to 1.44). Authors' conclusionsOverall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis though data on subsets of patients who may benefit more from treatment is lacking. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalization for a self-limiting condition, increased resistance to respiratory pathogens and cost of antibiotic treatment. |