Antibiotics Are Useless for Most Cases of Bronchitis

But doctors keep prescribing them, contributing to bacterial resistance, study says.

By Ed Edelson
HealthDay Reporter
Wednesday, November 15, 2006; 12:00 AM

Copyright © 2006 ScoutNews LLC. All rights reserved.

WEDNESDAY, Nov. 15 (HealthDay News) -- Most people who go to a doctor with the raspy breathing problem called bronchitis get an antibiotic. Most of them shouldn't, a new study contends.

Two physicians at the Virginia Commonwealth University School of Medicine surveyed the world literature on bronchitis -- research studies, clinical trials and anything related to bronchitis and its treatment.

"Physicians should be encouraged to avoid antibiotics in most cases," said Dr. Richard P. Wenzel, chairman of the department of internal medicine at Virginia Commonwealth and one of the authors of the report.

The findings are published in the Nov. 16 issue of the New England Journal of Medicine.

The primary reason for over-prescription of antibiotics is that most cases of bronchitis, which is inflammation of the tiny airways of the lungs, "are caused by agents for which we have no therapy yet," meaning viruses, Wenzel said. Only a small percentage of acute bronchitis cases are caused by bacteria that doctors can treat, such as whooping cough, he said.

Yet doctors keep prescribing antibiotics, he said. He estimated that 70 percent to 80 percent of bronchitis patients are given a course of antibiotics lasting five to 10 days.

That's a lot of antibiotics. One of every 20 American adults will get bronchitis in a given year, Wenzel said. A first reason for them not taking antibiotics is that the drugs cost money, in an era when the mounting cost of health care is a major concern, he said.

"And all antibiotics have side effects, such as rash, diarrhea and abdominal pain," Wenzel said. Side effects are acceptable only when a medication helps the patient, he said.

"The third reason for not prescribing antibiotics is the impressive pressure it puts on organisms to select more resistant strains, so that the ones we use will no longer be effective," Wenzel said. While economists worry about medical costs, physicians worry about antibiotic-resistant strains of bacteria.

With all those arguments against the practice, why do doctors still write those prescriptions?