Principles of Appropriate Antibiotic Use for Treatment of Uncomplicated Acute Bronchitis: Background
- Ralph Gonzales, MD, MSPH;
- John G. Bartlett, MD;
- Richard E. Besser, MD;
- Richelle J. Cooper, MD, MSHS;
- John M. Hickner, MD, MSc;
- Jerome R. Hoffman, MD, MA; and
- Merle A. Sande, MD
- From the University of Colorado Health Sciences Center, Denver, Colorado; Johns Hopkins University, Baltimore, Maryland; Centers for Disease Control and Prevention, Atlanta, Georgia; University of California, Los Angeles, Los Angeles, California; Michigan State University, East Lansing, Michigan; and University of Utah, Salt Lake City, Utah.
Abstract
The following principles of appropriate antibiotic use for adults with acute bronchitis apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease.
1. The evaluation of adults with an acute cough illness or a presumptive diagnosis of uncomplicated acute bronchitis should focus on ruling out serious illness, particularly pneumonia. In healthy, nonelderly adults, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lung sounds, and chest radiography is usually not indicated. In patients with cough lasting 3 weeks or longer, chest radiography may be warranted in the absence of other known causes.
2. Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of duration of cough. If pertussis infection is suspected (an unusual circumstance), a diagnostic test should be performed and antimicrobial therapy initiated.
3. Patient satisfaction with care for acute bronchitis depends most on physician–patient communication rather than on antibiotic treatment.
Article and Author Information
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*After the primary author (Dr. Gonzales), authors are listed in alphabetical order.
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In addition to the Centers for Disease Control and Prevention, the principles outlined in this document have been endorsed by the American Academy of Family Physicians, the American College of Physicians–American Society of Internal Medicine, and the Infectious Diseases Society of America.
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Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
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Acknowledgments: External review has included feedback from the Centers for Disease Control and Prevention; the American College of Physicians–American Society of Internal Medicine Clinical Efficacy Assessment Subcommittee; and representatives of the American Academy of Family Physicians, the American College of Emergency Physicians, and the Infectious Diseases Society of America.
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Role of the Funding Sources: Partial support for the development of the Principles was provided by the Centers for Disease Control and Prevention, and final approval by the Centers for Disease Control and Prevention of all manuscripts submitted for publication was required. Dr. Cooper is supported by a National Research Service Award (F32 HS00134-1) from the Agency for Healthcare Research and Quality.
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Requests for Single Reprints: Richard E. Besser, MD, Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, rbesser{at}cdc.gov.
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Current Author Addresses: Dr. Gonzales: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262.
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Dr. Bartlett: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 463A, Baltimore, MD 21287-0003.
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Dr. Besser: Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
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Drs. Cooper and Hoffman: UCLA Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024.
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Dr. Hickner: Department of Family Practice, Michigan State University, B-111 Clinical Center, East Lansing, MI 48824.
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Dr. Sande: Department of Medicine (4C104), University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132.
- Copyright ©2004 by the American College of Physicians
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