title: Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department.
abstract: BACKGROUND
  Although the overuse of antibiotics and underuse of bronchodilators for treatment of acute bronchitis is well known, few studies have analyzed these trends in the emergency department (ED).
  
  
  OBJECTIVE
  To characterize the antibiotic and bronchodilator prescribing practices of physicians at two academic EDs in the diagnosis of acute bronchitis, and to identify factors that may or may not be associated with these practices.
  
  
  METHODS
  A computer database was searched retrospectively for all patients with an ED discharge diagnosis of acute bronchitis, and analyzed, looking at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and several other related factors including age, gender, chief complaint, duration of cough, and comorbid conditions.
  
  
  RESULTS
  During the study period, there were 836 cases of acute bronchitis in adults. Of these, 622 (74.0%) were prescribed antibiotics. Of those prescribed antibiotics, 480 (77.2%) were prescribed broad-spectrum antibiotics. Using multivariate analysis (odds ratio, 95% confidence interval), antibiotics were prescribed significantly more often in patients aged 50 years or older (1.7, 1.2-2.5) and in smokers (1.5, 1.0-2.2). Of patients without asthma, 346 (49.9%) were discharged without a bronchodilator, and 631 (91.1%) were discharged without a spacer device.
  
  
  CONCLUSIONS
  Antibiotics are over-prescribed in the ED for acute bronchitis, with broad-spectrum antibiotics making up the majority of the antibiotics prescribed. Age ≥50 years and smoking are associated with higher antibiotic prescribing rates.
authors.affiliation: University of California (UC) San Diego School of Medicine, San Diego, California 92102, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kroening-Roche
authors.forename: Arash
authors.initials: A
authors.lastname: Soroudi
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D001991:Bronchitis / Q000150:complications / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D016001:Confidence Intervals; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D012907:Smoking
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents