Bronchitis ========== þ Albuterol vs Antibiotics for Bronchitis - albuterol inhaler decreased cough by 1.5 days compared to antibiotics; randomized all patients with dx of bronchitis in a FP setting. [Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract 1994;39:437-440.] þ Antibiotics or not for bronchitis? - Do we need more meta-analyses to know that antibiotics don't work for bronchitis? No. [Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995; 345:665-6.] - We know they don't work for nonsmokers, but do they work for smokers? No. [Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med 2002; 17:230-4. OBJECTIVE: Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis. DESIGN: A medline search was done using the keywords bronchitis, cough, and antibiotics to identify English language articles published from January 1966 to September 2001. Randomized, placebo-controlled trials of antibiotics in previously healthy smokers and nonsmokers with acute bronchitis were included. MEASUREMENTS AND MAIN RESULTS: For each study, we abstracted information on design, size, inclusion criteria, patient characteristics, and outcomes. Of 2,029 articles in the original search, 109 relevant articles were retrieved and reviewed. There have been no studies specifically addressing antibiotic use in smokers with acute bronchitis. Nine randomized, placebo-controlled trials of antibiotics have included 774 patients and over 276 smokers. Lack of subgroup reporting for smokers precluded meta-analysis. In 7 trials, smoking status did not predict or alter patients' response to antibiotics. In one trial, trimethoprim/sulfamethoxazole resulted in less-frequent cough overall, but not among smokers. In another trial, erythromycin reduced symptom scores only among nonsmokers while antibiotic-treated smokers had a trend toward higher symptom scores. CONCLUSION: Although no trials have specifically addressed antibiotic use in smokers with acute bronchitis, existing data suggest that any benefit of antibiotics is the same or less for smokers than for nonsmokers.] - many controlled studies show no benefit. [Orr PH, Scherer K, MacDonald A, Moffatt MEK. Randomized placebo-controlled trials of antibiotics for acute bronchitis: A critical review of the literature. J Fam Pract 1993;36(5):507-12.] [Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: Do antitiobic prescriptions improve outcomes? J Ohio Stat Med Assoc 1996;89:267-74.] [Mainous AG, Hueston WJ, Clark JR. Antibiotics and upper respiratory infection: Do some folks think there is a cure for the commmon cold? J Fam Pract 1996;42(4):357-61.] [Evans AT, et al. Azithromycin for acute bronchitis: A double-blind controlled trial. Lancet 2002;359:1648.] Cook County Hospital; 220 adults, no underlying lung disease (could be smokers) given five days of azithro vs. low-dose vitamin C, plus Robitussin DM and albuterol inhaler; no difference in rates of improvement, return to usual activities (89% at day 7), repeat visits, perceived adverse effects of meds. - can give antibiotics to: + smokers/older (but questionable based on above) or immunocompromised + fever + rales (KC's notes from an ID lecturer and from 1/20/98 Journal Club) Gonzales R; Sande M What will it take to stop physicians from prescribing antibiotics in acute bronchitis? [see comments] Lancet, 345: 8951, 1995 Mar 18, 665-6 Orr PH; Scherer K; Macdonald A; Moffatt ME Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the literature J Fam Pract, 36: 5, 1993 May, 507-12 BACKGROUND. Acute bronchitis is a common clinical problem that causes considerable morbidity and presents both diagnostic and treatment dilemmas for the physician. An evaluation of all published randomized controlled trials of antibiotics in the treatment of acute bronchitis was conducted to (1) quantitatively assess methodologic rigor, (2) determine if effectiveness of antimicrobial therapy is known, and (3) analyze strengths and weaknesses of randomized controlled trials in family practice settings. METHODS. A scoring system for the evaluation of randomized controlled trials was adapted for this study. Four raters, who were blinded to which journals published the studies and the type of antibiotic used in each study, assessed the six-randomized clinical trials for treatment of bronchitis identified through a literature search. The trials were rated according to criteria that measured internal validity. RESULTS. Scores for internal validity ranged from 65.5 to 102.5 points with a maximum possible score of 120 points (54.6% to 85.4%). The two trials with the highest scores assessed doxycycline and showed no benefit from use of this antibiotic. Single trials that studied erythromycin and trimethoprim-sulfamethoxazole showed improvement in outcome from use of these drugs; however, of the six trials, these two studies ranked fourth and fifth for internal validity. Low scores resulted from small sample size, possible contamination with other treatment measures, and poor assessment of subjects' compliance with antibiotic regimen. CONCLUSIONS. An evaluation of the current literature does not support antibiotic treatment for acute bronchitis. Further studies of this common illness are indicated. It is hoped that this critical review of randomized control trials will prove useful in the planning of future studies, in placing greater emphasis on methodologic rigor, and in giving greater consideration to the practical constraints of research in the family practice setting. þ Erythro has antitussive effect, they say.