Antibiotics once thought of as a miracle drug took yet another hit when a researcher found that antibiotic use in treating bronchitis is unnecessary and risky. "Clinicians often prescribe antibiotics to treat acute bronchitis despite scant evidence that this approach is effective". Stated Dr. William Hueston, University of Wisconsin Madison Medical School Department of Family Medicine Eau Claire in the Journal of Family Practice. Bronchitis, which is an inflammation of the lings of the major lung airways, can cause persistent cough as well as difficulty breathing and other discomfort. Many medical doctors continue to use antibiotics as a treatment despite proof that acute bronchitis is usually triggered by viral infections which do not respond to antibiotics.

Surprisingly Dr. Hueston tried to put at least part of the blame on patients themselves when he said, "Evidence suggests that physicians may prescribe antibiotics because of an expectation that the patient wants an antibiotic." Such a conclusion would seem illogical since Hueston himself admitted that routine prescriptions for antibiotics "increase the medical cost per episode by about 16%" even with the use of relatively cheap antibiotics such as erythromycin.

In fact, he added that he wondered "whether patients are willing to pay this extra cost for a small chance of quicker relief from their cough or to avoid the inconvenience of having to return to the physician if their cough persists."

In antibiotics were merely expensive placebos the continued use of them for bronchitis and other viral infections might be as worrisome. However as Hueston pointed out, "Growing concerns about increasing antimicrobial resistance presumably linked to antibiotic overuse indicate that re-evaluation of the use of antibiotics may be warranted."

Doctors, who try to justify their prescriptions for antibiotics by saying "the patient wanted them," can solve the problem with patient education and explanations. Once they understand the facts, Hueston said, patients remain "satisfied with their care," even when antibiotics are not prescribed.

Although about 5-10% of bronchitis cases are caused by a bacteria and not a virus, and therefore might possibly respond to antibiotics, the test needed to determine this is expensive and inaccurate Hueston pointed out. He believes that best ways to treat bronchitis is the wait and see approach. Most cases of bronchitis are "self-limited" and resolve themselves in a few weeks.

Source The Journal of Family Practice 1997;44(3):261-265