JAMA: Antibiotic prescribing rate for acute bronchitis at 70% when it should be zero

CHICAGO — Despite clear evidence of ineffectiveness, guidelines and more than 15 years of educational efforts stating that the antibiotic prescribing rate for acute bronchitis should be zero, the rate was about 70% from 1996 to 2010 and increased during this time period, according to a study in the May 21 issue of JAMA.

"Avoidance of antibiotic overuse for acute bronchitis should be a cornerstone of quality health care," stated Michael Barnett, co-author from the Brigham and Women's Hospital, Boston. "Antibiotic overuse for acute bronchitis is straightforward to measure. Physicians, health systems, payers and patients should collaborate to create more accountability and decrease antibiotic overuse.

Acute bronchitis is a cough-predominant respiratory illness of less than three weeks' duration. For more than 40 years, trials have shown that antibiotics are not effective for this condition. Despite this, between 1980 and 1999, the rate of antibiotic prescribing for acute bronchitis was between 60% and 80% in the United States. During the past 15 years, the Centers for Disease Control and Prevention has led efforts to decrease prescribing of antibiotics for acute bronchitis. Since 2005, a Healthcare Effectiveness Data and Information Set measure has stated that the antibiotic prescribing rate for acute bronchitis should be zero, according to background information in the article.

Researchers found that of 3,153 sampled acute bronchitis visits between 1996 and 2010 that met study inclusion criteria, the overall antibiotic prescription rate was 71% and increased during this time period. There was a significant increase in antibiotic prescribing in emergency departments. Physicians prescribed extended macrolides (a type of antibiotics) at 36% of acute bronchitis visits, and extended macrolide prescribing increased from 25% of visits in 1996 to 1998 to 41% in 2008-2010. Other antibiotics were prescribed at 35% of visits.