Evaluation and treatment of acute bronchitis at an academic teaching clinic.
BACKGROUND
Randomized controlled trials have demonstrated that antibiotics provide no benefit for acute bronchitis, yet 55 to 90% of patients who receive this diagnosis are treated with antibiotics. Given substantial data against antibiotics for acute bronchitis, it could be expected that physicians at academic teaching institutions would be less likely to prescribe antibiotics. However, limited data of antibiotic use for acute bronchitis in this setting has been published.


METHODS
Charts of patients seen between January 1 and October 25, 2000, who received an ICD-9 diagnosis of acute bronchitis or upper respiratory infection (URI) at the University of Virginia internal medicine clinic were reviewed. Patients were excluded if they had no cough, chronic obstructive pulmonary disease, symptoms for > or = 3 weeks, or antibiotics for another reason.


RESULTS
Of the 160 patients included in this study, 105 (66%) received an antibiotic. Multivariate analysis revealed that patients with increasing age (P = 0.002), purulent cough (P = 0.003), abnormal exam (P = 0.003), and comorbidities (P = 0.03) were most likely to receive an antibiotic. Smoking, duration of symptoms, gender, and race did not predict antibiotic use (P > 0.05). Macrolides accounted for 68% of antibiotics. Twenty-two (14%) of all patients received a chest radiograph and 72 (45%) received an inhaler. Of those who had chest radiographs negative for signs of infection, 76% received an antibiotic.


CONCLUSIONS
In our teaching clinic, antibiotics were overused, whereas chest radiographs and inhalers were underused for the evaluation and treatment of acute bronchitis. Recently published guidelines will help curb use of antibiotics, but a more intensive intervention, including physician and patient education is probably necessary.
Hall
Keri K
KK
University of Virginia Health Systems, Charlottesville, Virginia 22908, USA.
Philbrick
John
J
Nadkarni
Mohan
M
D000208:Acute Disease; D000375:Aging; D000554:Ambulatory Care Facilities; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003371:Cough; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D006801:Humans; D038801:International Classification of Diseases; D007396:Internship and Residency; D018942:Macrolides; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011859:Radiography; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012189:Retrospective Studies; D013663:Teaching; D014495:Universities
D000900:Anti-Bacterial Agents; D018942:Macrolides