[Can use of antibiotics in acute bronchitis be reduced?]

Abstract

Background: Acute bronchitis is one of the most common illnesses treated in the primary care setting. Most patients are treated with antibiotics, despite the fact that acute bronchitis is often a viral infection. There is little evidence that antibiotics are of any value in the treatment of this illness. Inappropriate use of antibiotics in the treatment of this and other infectious diseases contributes to the development of resistant bacteria. The purpose of this study was to reduce the prescribing of antibiotics for acute bronchitis in patients without underlying lung disease in the acute care clinic in Arendal, Norway.

Material and methods: The study had three phases, the first of which was a pilot study showing that 87% of patients with acute bronchitis received a prescription for antibiotics. The next phase was an educational intervention in which the physicians were informed of the inappropriately high prescribing rate, the lack of evidence that antibiotics are useful in the treatment of acute bronchitis, and the potential of C reactive protein (CRP) in the diagnose of this illness. The third phase of the study examined the treatment given to patients after the intervention.

Results: The antibiotic prescribing rate was reduced from 87% to 71% after the intervention. Doxycycline was prescribed most often, followed by penicillin and erythromycin. The use of CRP increased, and the rate of antibiotic prescriptions for patients with CRP < or = 20 was reduced after the intervention. There were fewer bronchitis diagnoses and more pneumonia diagnoses made after the intervention.

Interpretation: An educational intervention designed for prescribing doctors may reduce the use of antibiotics in the treatment of acute bronchitis.