Current Management of Acute Bronchitis in Ambulatory CareThe Use of Antibiotics and Bronchodilators
Arch G. Mainous III, PhD;
Roger J. Zoorob, MD;
William J. Hueston, MD
Arch Fam Med. 1996;5(2):79-83.
Abstract
Objective
To examine the treatment regimens for acute bronchitis in adults in a Medicaid population seen in ambulatoryttings.
Design
Cross-sectional sample of Kentucky Medicaid claims (July 1, 1993, through June 30, 1994).
Participants
Individuals 18 years old or older seen in an ambulatory setting for acute bronchitis. Anyone with a primary diagnosis of asthma or chronic obstructivemonary disease within the time frame was excluded. Twelve hundred ninety-fours accounted for 1635 separate outpatient and emergency department encounters for acute bronchitis. Outpatient visits accounted for 89% (n=1448) encounters.
Results
In 22% (n=358) encounters, no medication was prescribed; in 61% (n=997), antibiotics alone were prescribed, in 3% (n=43), odilators alone were prescribed; and in 14% (n=237antibiotics and bronchodilators were prescribed. Some type of medication was more likely to be prescibed emergency departments than in outpatient settings (P=.04), and antibiotic/bronchodilator combination therapy was more likely to be prescribed in rural practices than in urban practices (P<.001). Broadspectrum antibiotics were more likely than narrowspectrum antibiotics to be used in combination with a bronchodilator (P=.001). Penicillins were the most widely used antibiotics (37%), but broad-spectrum agents, such as second- and third-generation cephalosporins (10%) and fluoroquinolones (5%), were also prescribed.
Conclusions
Although evidence suggests that antibiotic treatment is not usually indicated for treatment of acute bronchitis, these results indicate that antibiotics are still the predominant treatment regimen in ambulatory care. Furthermore, the evidence suggesting that bronchodilators are effective symptomatic treatments has not been widely adopted. These results have significant implications for the production of antibiotic-resistant bacteria and suggest investigation into why physicians have not used this information in their treatment of acute bronchitis.
Author Affiliations
From the Department of Family Practice (Drs Mainous and Zoorob), University of Kentucky, Lexington; and the Eau Claire Family Practice Residency, Department of Family Medicine, University of Wisconsin—Madison (Dr Hueston).
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