Antibiotics for acute bronchitis

Smith, Susan M; Fahey, Tom; Smucny, John; Becker, Lorne A

doi:10.1002/14651858.cd000245.pub3

Cited by 122 publications

(76 citation statements)

References 42 publications

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“…Overall, our results are consistent with previously published research on childhood acute bronchitis, [11] with a predominance of acute cough in all cases. Twentyeight percent of our participants had a productive cough with purulent sputum.…”

Section: Discussionsupporting

confidence: 93%

“…Twentyeight percent of our participants had a productive cough with purulent sputum. These findings are consistent with other studies, [11,12] in which >50% of parents described the cough as dry, the remainder reporting it to be productive or of a mixed type. As has been reported by others, [13,14] we found that the colour of the sputum had no predictive value for the diagnosis of bacterial bronchitis or for differentiating between pneumonia and bronchitis.…”

Section: Discussionsupporting

confidence: 92%

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Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Moawad¹,

Haron²,

Maher³

et al. 2017

S Afr Med J

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Background. Despite evidence of limited benefit of antibiotics in acute bronchitis, most paediatric patients are prescribed them. Objectives. To assess the validity of the Bronchitis Severity Score (BSS) in assessing the clinical response to treatment of acute bronchitis, and determine whether clinical data and basic laboratory measurements can be used to guide antibiotic prescription. Methods. We enrolled 200 patients (age range 6 months 12 years) with clinically diagnosed acute bronchitis. They were divided into three groups according to age. All patients were evaluated three times during the bronchitis episode (days 0, 5 and 7). The primary outcome measurement was the change in the BSS from day 0 to day 7. Results. On the initial visit, the mean (standard deviation (SD)) BSS was 8.36 (2.6), indicating moderate severity of bronchitis. The mean BSS decreased to 4.03 (2.3) on day 5 and to 2.36 (1.45) on day 7. Initial blood tests showed anaemia (80%), leucocytosis (6%), bandaemia (3%) and lymphocytosis (52%). Only four patients were positive for Creactive protein, while the erythrocyte sedimentation rate was elevated in 98% of cases. There were significant correlations between bandaemia, fever grade (p<0.001) and white blood cell count with clinical variables such as the presence of secretions on chest auscultation (p<0.05) and toxic facies on general examination (p<0.05). Conclusions. Acute bronchitis in children is a selflimiting disease that does not require routine administration of antibiotics. The BSS is a simple and practical clinical scoring system that is useful in evaluating disease severity and monitoring disease resolution in acute bronchitis.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Moawad¹,

Haron²,

Maher³

et al. 2017

S Afr Med J

View full text Add to dashboard Cite

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“…Nevertheless, up to 90% of episodes of acute respiratory illness in otherwise healthy individuals are considered to be of viral origin [1,3,[7][8][9]. Accordingly, the diagnosis of acute bronchitis is based on clinical symptoms and aims to rule out serious conditions (e. g. asthma) and severe bacterial infections, especially pneumonia.…”

Section: Original Articlementioning

confidence: 99%

“…Investigations on the appropriate treatment of cough revealed that the patients' pressure and expectations lead a majority of physicians to the unnecessary prescription of antibiotics [8,37] although several guidelines and meta-analyses have found no benefit in the use of antibiotics for the treatment of acute bronchitis [3,5,8,9,14,38,39]. A recent Cochrane review meta-analysis including 17 clinical trials exposed no difference in clinical improvement when antimicrobial treatment was compared with placebo [3]. In order to provide rapid symptom relief for patients suffering from acute bronchitis, herbal remedies and their monoterpenoid constituents (e. g. cineole, linalool, camphor) may constitute a well-tolerated and well-evidenced alternative to the prescription of antibiotics, thus not only reducing antibiotic use but also the global risk of bacterial resistance development.…”

Section: Ear and Labyrinth Disordersmentioning

confidence: 99%

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Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial

Kähler

Dereziński²,

Bocian-Sobkowska³

et al. 2017

Wien Med Wochenschr

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SummaryBackground The trial aimed to evaluate the efficacy and safety of Spicae aetheroleum (Spicae ae.), a phytomedicine obtained by steam distillation of the flowering tops of Lavandula latifolia, as compared to placebo in adult patients with acute bronchitis. Methods Patients with uncomplicated acute bronchitis (bronchitis severity score [BSS] ≥ 5 score points) were randomly assigned to treatment with Spicae ae. or placebo in a double-blind, parallel-group design. No additional treatment was admitted. The primary objective was the mean difference of a defined total BSS of 25% between the Spicae ae. and the placebo group after 7 days of full medication dose. Secondary endpoints included the BSS at day 10, additional signs and symptoms of bronchitis, quality of life (QoL) and safety. Results The mean decrease in BSS at day 7 and day 10 was significant with 4.79 vs. 3.20 (p < 0.005 for a 25% difference) and 6.47 vs. 4.32 (p < 0.009 for a 25% difference) score points respectively in the Spicae ae. (n = 119) vs. placebo group (n = 110). Accordingly, most additional signs and symptoms of acute bronchitis as well as the patients' QoL improved significantly with Spicae ae. as compared to placebo. In all, 258 patients were eligible for safety analysis. The treatment with Spicae ae. was well tolerated; no serious adverse events occurred. Conclusion The defined objectives both for the primary and secondary endpoints have been met. The results of this study provide evidence that Spicae ae. is well tolerated, effective and superior to placebo in the symptomatic treatment of uncomplicated acute bronchitis in adult patients.

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Antibiotics for acute bronchitis

Smith

Fahey

Smucny³

et al. 2017

Cochrane Database of Systematic Reviews

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We found limited evidence of clinical benefit to support the use of antibiotics for acute bronchitis. Some people treated with antibiotics recovered a bit more quickly with reduced cough-related outcomes. However, this di erence may not be of practical importance as it amounted to a di erence of half a day over an 8-to 10-day period. There was a small but significant increase in adverse side e ects in people treated with antibiotics. The most commonly reported side e ects included nausea, vomiting, diarrhoea, headache, and rash. This review suggests that there is limited benefit to the patient in using antibiotics for acute bronchitis in otherwise healthy individuals. More research is needed on the e ects of using antibiotics for acute bronchitis in frail, elderly people with multiple chronic conditions who may not have been included in the existing trials. Antibiotic use needs to be considered in the context of the potential side e ects, medicalisation for a self limiting condition, cost of antibiotic treatment, and in particular associated population-level harms due to increasing antibiotic resistance. Quality of the evidence The quality of these trials was generally good, particularly for more recent studies.

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Antibiotics for acute bronchitis

Cited by 122 publications

References 42 publications

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial

Antibiotics for acute bronchitis

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