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Antibiotics and Bronchitis: Yet Another Failure

Azithromycin was no more effective than vitamin C in patients with acute bronchitis.

Acute bronchitis is one of the most commonly diagnosed diseases in the emergency department and is the cause of more than 10 million doctor visits every year. Most patients are prescribed antibiotics, despite concerns about growing antibiotic resistance and substantial evidence that antibiotics are ineffective for treating bronchitis. These authors evaluated the effectiveness of azithromycin for treating bronchitis in a multicenter, randomized, double-blind study.

Of 448 patients assessed for possible bronchitis (productive or nonproductive cough lasting for 2-14 days without evidence of pneumonia), 340 were diagnosed with bronchitis, and 220 met the criteria for randomization. Of the 189 patients who completed the study, 97 received 250 mg/day of azithromycin, and 92 received 250 mg/day of vitamin C. All patients also received dextromethorphan syrup and an albuterol inhaler to use every 6 hours as needed. Cough symptoms and limitations on activity were assessed at 3 and 7 days. No statistically significant differences between groups were identified. Although the authors had determined that 400 patients were needed to have sufficient statistical power to detect no difference in treatment between azithromycin and vitamin C, they stopped the study when a preliminary analysis indicated that it was unlikely that more patients would change the outcome.

Comment: What more do we need to hear? This is another of several studies demonstrating that antibiotics are not indicated for bronchitis, regardless of sputum production. ß₂-agonists, such as albuterol, have been proven to reduce symptoms, and cough suppressants may improve patient comfort, but, except for these medications, keep that prescription pad in your pocket!

— James Scott, MD

Published in Journal Watch Emergency Medicine July 31, 2002

Citation(s):

Evans AT et al. Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial. Lancet 2002 May 11; 359:1648-54.

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