Current management of acute bronchitis in ambulatory care: The use of antibiotics and bronchodilators
A. G. Mainous 3rd, R. J. Zoorob and W. J. Hueston
Department of Family Practice, University of Kentucky, Lexington, USA.
OBJECTIVE: To examine the treatment regimens for acute bronchitis in adults
in a Medicaid population seen in ambulatory care settings. DESIGN:
Cross-sectional sample of Kentucky Medicaid claims (July 1, 1993, through
June 30, 1994). PARTICIPANTS: Individuals 18 years old or older seen in an
ambulatory setting for acute bronchitis. Anyone with a primary diagnosis of
asthma or chronic obstructive pulmonary disease within the time frame was
excluded. Twelve hundred ninety-four individuals accounted for 1635
separate outpatient and emergency department encounters for acute
bronchitis. Outpatient visits accounted for 89% (n=1448) of the encounters.
RESULTS: In 22% (n=358) of the encounters, no medication was prescribed; in
61% (n=997), antibiotics alone were prescribed, in 3% (n=43),
bronchodilators alone were prescribed; and in 14% (n=237), both antibiotics
and bronchodilators were prescribed. Some type of medication was more
likely to be prescribed in emergency departments than in outpatient
settings (P=.04), and antibiotic/bronchodilator combination therapy was
more likely to be prescribed in rural practices than in urban practices
(P<.001). Broad-spectrum were more likely than narrow-spectrum
antibiotics to be used in combination with a bronchodilator (P=.001).
Penicillins were the most widely used antibiotics (37%), but broad-spectrum
agents, such as second- and third-generation cephalosporins (10%) and
fluoroquinolones (5%), were also prescribed. CONCLUSIONS: Although evidence
suggests that antibiotic treatment is not usually indicated for treatment
of acute bronchitis, these results indicate that antibiotics are still the
predominant treatment regimen in ambulatory care. Furthermore, the evidence
suggesting that bronchodilators are effective symptomatic treatments has
not been widely adopted. These results have significant implications for
the production of antibiotic-resistant bacteria and suggest investigation
into why physicians have not used this information in their treatment of
acute bronchitis.
One hundred coughs: Family practice case series
Worrall
cfp 2008;54:236-237.
ABSTRACT
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Trends in Antimicrobial Prescribing for Bronchitis and Upper Respiratory Infections Among Adults and Children
Mainous et al.
Am. J. Public Health 2003;93:1910-1914.
ABSTRACT
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Antibiotics for Common Respiratory Tract Infections in Adults
Hirschmann
Arch Intern Med 2002;162:256-264.
ABSTRACT
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Management of adult lower respiratory tract infection in primary care
STEELE et al.
Thorax 2001;56:87-88.
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Does Drug Treatment of Patients With Acute Bronchitis Reduce Additional Care Seeking?: Evidence From the Practice Partner Research Network
Hueston et al.
Arch Fam Med 2000;9:997-1001.
ABSTRACT
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Antibiotics for Upper Respiratory Tract Infections: Follow-up Utilization and Antibiotic Use
Hueston et al.
Arch Fam Med 1999;8:426-430.
ABSTRACT
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National Trends in the Use of Antibiotics by Primary Care Physicians for Adult Patients With Cough
Metlay et al.
Arch Intern Med 1998;158:1813-1818.
ABSTRACT
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Antibiotics for Colds in Children: Who Are the High Prescribers?
Mainous III et al.
Arch Pediatr Adolesc Med 1998;152:349-352.
ABSTRACT
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