Antibiotics: neither cost effective nor 'cough' effective

Abstract

Background: Clinicians often prescribe antibiotics to treat acute bronchitis despite scant evidence that this approach is effective at speeding symptom resolution. Because patients infected with bacteria but not treated with antibiotics may need to return in the future for therapy, however, this approach may be cost effective.

Methods: To evaluate the cost of various treatment strategies to treat acute bronchitis, this study examined three different strategies including: (1) withholding antibiotics and treating only patients with persistent cough; (2) screening patients for Mycoplasma pneumoniae or Chlamydia pneumoniae and treating all patients with positive results with antibiotics; and (3) treating all patients with antibiotics. The cost analysis was approached from the patient's perspective. The main outcome measured was the cost per person in whom acute bronchitis was diagnosed.

Results: Withholding antibiotics and treating only patients with a persistent cough was the most cost-effective strategy given the baseline assumptions. If the cost per patient visit was over $110, the cost of an initial course of antibiotics less than $2.72, or the prevalence of bacterial infection greater than 25%, then treatment of all patients was more cost effective. Assuming a screening test of 90% sensitivity and specificity, the screening strategy was only cost effective if the cost of the screening test was less than $2.35, or less than $3.80 if the test had no false-positive or false-negative results.

Conclusions: Under most circumstances, the most cost-effective strategy for treating acute bronchitis is to withhold antibiotics and treat only patients whose cough does not resolve.