Johns Hopkins professor Peter B. Terry, M.D. explains how overuse can lead to antibiotic resistance.
Many people who develop bronchitis go to their physician assuming they’ll receive antibiotics to clear up the bronchitis. But a recent study found that people with bronchitis or other uncomplicated lower respiratory tract infections who take antibiotics for their condition have little difference in relief of symptoms compared with patients who don’t take antibiotics.
The study, published in the Journal of the American Medical Association, included 807 patients with bronchitis or a similar uncomplicated lower respiratory tract infection. It did not include patients with chronic lung disease or suspected pneumonia. Participants were randomly assigned to receive either immediate antibiotics, no antibiotics, or delayed antibiotics if bronchitis symptoms had not gone away after 10 days.
Compared with immediate antibiotics, giving patients either no antibiotics or delayed antibiotics was associated with little difference in the duration or severity of bronchitis symptoms. On average, patients were ill with bronchitis for three weeks in total; taking antibiotics reduced moderately bad bronchitis symptoms an average of only one day. “It is difficult to justify widespread antibiotic prescribing for uncomplicated lower respiratory tract infection on this basis given the dangers of antibiotic resistance,” the researchers concluded.
The researchers also found that the approaches of not offering antibiotics or using delayed antibiotics were both acceptable to most bronchitis patients. “I hope that this study makes physicians think more carefully about prescribing antibiotics to patients with bronchitis and other uncomplicated lower respiratory infections,” says Peter B. Terry, M.D., author of the John Hopkins Lung Disorders White Paper and Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.
Dr. Terry notes that a number of studies over the last several decades have clearly shown that about half of cases of acute bronchitis are caused by a virus. “Since antibiotics don’t work against viruses, then in these patients, taking an antibiotic won’t alter the natural course of their bronchitis.” But, Dr. Terry adds, some patients with bronchitis have bacteria growing in their airways and then become infected with a virus that encourages the bacteria to multiply, leading to pneumonia. “These bronchitis patients will respond to antibiotics,” Dr. Terry says. “The problem becomes how to know when a patient’s bronchitis is viral or not. That’s where a doctor’s judgment comes in.”
Absence of a fever and clear or light yellow phlegm usually suggests the bronchitis is viral, while fever, and dark yellow or green sputum that is thick and sticky is more suggestive of bacterial bronchitis infection. A doctor also needs to take into account the age and general health of the patient, according to Dr. Terry. “There are certain considerations a physician has to think about very carefully. If you’re young and healthy and get acute bronchitis, you are likely to have a strong enough immune system to fight it off. But if you have severe chronic obstructive pulmonary disease [an infection that further narrows already damaged airways and compromises lung function], physicians tend to be more conservative with these patients.”
