High Rate of Antibiotic Prescribing for Acute Bronchitis — Still!

May 29, 2014

High Rate of Antibiotic Prescribing for Acute Bronchitis — Still!

  1. Thomas L. Schwenk, MD

Clinicians continue to ignore evidence-based recommendations against antibiotic therapy.

  1. Thomas L. Schwenk, MD

During the past 15 years, national education programs have focused on eliminating inappropriate use of antibiotics generally and expensive, broad-spectrum antibiotics specifically. To determine whether these programs have had any effect, investigators used data from two national surveys of ambulatory care in physicians' offices and hospital outpatient facilities to assess antibiotic prescribing in 3153 visits by adults for acute bronchitis — a diagnosis for which guidelines explicitly advise against antibiotic therapy in patients without chronic lung disease. Visits that resulted in hospitalization or were associated with chronic pulmonary disease, immunodeficiency, cancer, or other serious conditions were excluded.

Between 1996 and 2010, the overall rate of antibiotic prescribing was 71%, with little variation by patients' age, sex, race, or insurance status, or by region or population density (rural or urban); prescribing rates were similar in primary care and emergency department settings, and prescribing increased in both settings (significantly so in emergency departments). Prescribing of extended macrolides increased from 25% to 40% during the 15-year study. Other antibiotics — most commonly, broad-spectrum antibiotics — were prescribed at 35% of visits.


The authors bemoan the apparent lack of effect of 15 years of practice guideline dissemination, evidence-based exhortations, and educational efforts, although the antibiotic prescribing rate for acute bronchitis might have been even higher by now without these measures. Physician education, of whatever sort, apparently is not the key factor.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate


Reader Comments (7)

Judith Sylvia Walker PhD Other Healthcare Professional, Infectious Disease

Dear Dr Thomas L. Schwenk, MD
Clinicians continue to ignore evidence-based recommendations against antibiotic therapy.

I agree this is a very important topic to eliminate AMR. More governance is needed. This topic is worthy of a PhD. Does nayone know of funding to support a PhD in this valuable area?

lisa clemons Physician, Family Medicine/General Practice, blackstock family health center

its very sad that doctors cannot follow this very simple medical advise. its time to stand up and say to patients/family members, etc, that what we are doing in NOT prescribing antibiotics IS the correct medical care.

Matt Kosel Other Healthcare Professional, Family Medicine/General Practice

hmmmm... the prescribing rate for pain medication, benzodiazepines, sleep medication, antibiotics and disability are all up. I agree i don't think it's lack of education, I think that providers just can't say no.

irshad parray Physician, Internal Medicine, govt agency

Common practice here also as it is difficult to diff clinically btw bact and viral

Joshua Hayes FNP Other Healthcare Professional, Emergency Medicine

The problem that I see at this juncture is the fact that patient satisfaction has taken precedence over proper treatment. The public and hospital administration types need to be educated as well. I suspect as reimbursement becomes more entwined in satisfaction scores the problem will only become worse. All too often a patient will go to a different provider if the first one did not give them what they feel they need for their cough which is typically some sort of ABX.

Will Wiggins Medical Student

Interesting bit...Generally, trends like this are common where I study also. Doctors seem to prefer going the ´safe´ route by prescribing antibiotics.

PASCAL BASTIEN Physician, Internal Medicine, Toronto

Surely no one would say that to patients with C. difficile, TEN and other antibiotic-induced complications. Have a look at what this practice has caused in terms of antimicrobial resistance pattern in countries like the US. There is nothing "safe" about antibiotic misuse, and erring on the "antibiotic side" does not equate to the "safe side".

Physicians inability to comply with evidence-based guidelines of this kind is exactly why antibiotic stewardship, and soon culture stewardship are so needed. They are making it too obvious that our profession needs arbiters to redirect us ...

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