evidence & practice / cochrane corner series: 11

COCHRANE REVIEW SUMMARY

Antibiotics for acute bronchitis

Tanner M, Roddis JK (2018) Antibiotics for acute bronchitis. Nursing Standard. 32, 27, 41-43.
Date of submission: 29 January 2018; date of acceptance: 29 January 2018. doi: 10.7748/ns.2018.e11123

Melanie Tanner Summary statement

Senior lecturer in adult
nursing, School of Health
Sciences and Social Work,
University of Portsmouth,
Portsmouth, England, and
member of the Cochrane
Nursing Care Field
Jennifer Karen Roddis
Lecturer in adult nursing,
School of Health Sciences
and Social Work,
University of Portsmouth,
Portsmouth, England, and
member of the Cochrane
Nursing Care Field
The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes
through increasing the use of the Cochrane Library and supporting Cochrane’s role by
providing an evidence base for nurses and healthcare professionals who deliver, lead or
research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent
nursing-care-relevant Cochrane Reviews that are regularly published in collaborating
nursing-related journals. Information on the processes CNCF has developed can be
accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This
is a Cochrane review summary of: Smith SM, Fahey T, Smucny J et al (2017) Antibiotics
for acute bronchitis. Cochrane Database of Systematic Reviews. Issue 6. CD000245.
doi: 10.1002/14651858.CD000245.pub4.
Keywords
acute bronchitis, antibiotics, Cochrane review summary, respiratory system,
respiratory tract infection

Correspondence
melanie.tanner@port.
ac.uk
Conflict of interest
None declared
Online
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ACUTE BRONCHITIS is characterised
by inflammation of the bronchi of
the lungs. Symptoms include a cough,
increased mucus production, fever,
sore throat and general malaise. These
symptoms typically last one to three
weeks (Gonzales and Sande 2000),
but the cough can last for four weeks
or more (Wenzel and Fowler 2006).
Acute bronchitis is commonly caused
by a virus, such as influenza, respiratory
syncytial virus or rhinovirus. Other
causes may include bacterial infections
such as Streptococcus pneumoniae,
Haemophilus influenzae and
Staphylococcus aureus.
It has been estimated that there
are between 300 and 400 patient
consultations for treatment of respiratory
tract infections per 1,000 patients
annually in the UK (Gulliford et al
2011). In addition, many patients with
respiratory tract infections choose to
self-manage their condition. Historically,
antibiotics have been prescribed to
treat acute bronchitis (Franks and
Gleiner 1984, Verheij et al 1990,
Nordenstam et al 1992). Despite
global health recommendations to
reduce antibiotic prescriptions for
this condition, largely because of the
increase in antibiotic resistance, data
suggest that the prescribing pattern
for these medicines remains largely
unchanged (Gulliford et al 2014,
Malo et al 2016, Chakroun et al 2017,
Grigoryan et al 2017, McCullough et al
2017).
Objectives/aim
The aim of the Cochrane review was
to assess the use and adverse effects of
antibiotics in the treatment of acute
bronchitis. It was an update of previous
reviews, most recently undertaken by
Smith et al (2014).
Intervention/methods
The authors searched six databases –
Cochrane Central Register of Controlled

nursingstandard.com volume 32 number 27 / 28 February 2018 / 41

evidence & practice / cochrane corner series: 11
Trials, MEDLINE, Embase, LILACS,
World Health Organization (WHO)
International Clinical Trials Registry
Platform, and Clinicaltrials.gov – to
identify research related to bronchitis,
respiratory tract infections, lower
respiratory tract infections and antibiotics.
The Cochrane Central Register of
Controlled Trials, MEDLINE, Embase
and LILACS were accessed in January
2017, while the WHO International
Clinical Trials Registry Platform and
Clinicaltrials.gov were searched in April
2017. There were no restrictions on the
language of publication.
The review included randomised
controlled trials that compared an
antibiotic with either no treatment or
placebo to treat acute bronchitis. It
excluded trials that compared differing
antibiotic treatments or comparisons
of antibiotics with alternative drug
regimens, for instance bronchodilators.
The review also included studies that
permitted simultaneous use of antibiotics
and other medicines, such as those that
relieve pain, cough, fever and/or mucus
production, in cases where they were
taken by all participants involved in
the trial.
Results
A total of 17 studies were included in
the review, of which 16 were trials that
compared antibiotic use with placebo.
A total of 5,099 participants were
involved in the trials. No new studies
were identified since the Smith et al (2014)
review update. Several studies found that
some individuals treated with antibiotics
experienced reduced coughing half a day
sooner compared with those who were
not treated with antibiotics, over a
period of 8-10 days. However, adverse
effects of antibiotics were reported
in all but four studies, with the most
common being nausea, vomiting,
diarrhoea, headaches and rashes.
Although these adverse effects
were mild, they were experienced
comparatively frequently.
Prescribing antibiotics to particular
patient groups with acute bronchitis
42 / 28 February 2018 / volume 32 number 27
might have some benefit; however,
the extent of this is unclear because
of a lack of evidence. For instance,
older people with multiple long-term
conditions might benefit from antibiotic
treatment, but these patients were not
well-represented in the research.
Conclusion
The review demonstrated that there is
insufficient evidence to support the use
of antibiotics to treat acute bronchitis in
the general adult population. In addition,
the potential adverse effects of antibiotics
should be considered when making
treatment decisions.
IMPLICATIONS FOR PRACTICE
»» There are several assumed benefits
of treating respiratory tract infections
with antibiotics, including actual and
perceived symptom relief. However,
in the treatment of acute bronchitis
specifically, there is little evidence to
show that antibiotics significantly
improve associated symptoms in the
general adult population.
»» It is essential that patients and
healthcare practitioners are informed
about alternative treatment options to
antibiotics, to enable open discussions
about treatment decisions. The review
provides evidence that healthcare
practitioners can use to demonstrate to
patients that antibiotics should not be
prescribed for acute bronchitis, which is
particularly important given the effects
of antibiotic resistance.
»» Nurses should advise patients that
self-care strategies, such as rest,
increasing fluid intake and the use of
antipyretic and non-steroidal anti-
inflammatory drugs, can relieve symptoms
of acute bronchitis (National Institute
for Health and Care Excellence (NICE)
2015). For patients who are at lower
risk of developing complications such
as pneumonia, delayed prescriptions
for antibiotics could be issued, with
appropriate ‘safety netting’ advice to
ensure that patients with unresolved
or worsening symptoms know when and
how to access further care (NICE 2015).
However, it is important to undertake
a holistic assessment of each patient
to identify where antibiotics may be
beneficial.
nursingstandard.com
References

Chakroun M, Chakroun A, Hsairi M (2017)
Antibiotherapy management in respiratory
infections in ambulatory in Tunisia.
International Arabic Journal of Antimicrobial
Agents. 7, 1, 5. doi: 10.3823/805.
Franks P, Gleiner JA (1984) The treatment
of acute bronchitis with trimethoprim and
sulfamethoxazole. Journal of Family Practice.
19, 2, 185-190.
Gonzales R, Sande MA (2000) Uncomplicated
acute bronchitis. Annals of Internal Medicine.
133, 12, 981-991.
Grigoryan L, Zoorob R, Shah J et al (2017)
Antibiotic prescribing for uncomplicated
acute bronchitis is highest in younger
adults. Antibiotics, 6, 4, E22. doi: 10.3390/
antibiotics6040022.
Gulliford MC, van Staa T, McDermott L et al
(2011) Cluster randomised trial in the General
Practice Research Database: 1. Electronic
decision support to reduce antibiotic
prescribing in primary care (eCRT study).
Trials. 12, 115. doi: 10.1186/1745-6215-12-115.
Gulliford MC, Dregan A, Moore MV et al
(2014) Continued high rates of antibiotic
prescribing to adults with respiratory
tract infection: survey of 568 UK general
practices. BMJ Open. 4, e006245. doi:10.1136/
bmjopen-2014-006245.
Malo S, Poblador-Plou B, Prados-Torres A et al
(2016) Poor congruence with guidelines in
the use of antibiotics for acute bronchitis: a
descriptive study based on electronic health
records. Family Practice. 33, 5, 471-475.
McCullough AR, Pollack AJ, Plejdrup Hansen
M et al (2017) Antibiotics for acute respiratory
infections in general practice: comparison
of prescribing rates with guideline
recommendations. Medical Journal of
Australia. 207, 2, 65-69.
National Institute for Health and Care
Excellence (2015) Chest Infections - Adult.
Scenario: Acute Bronchitis. cks.nice.org.
uk/chest-infections-adult#!scenario (Last
accessed: 15 February 2018.)
Nordenstam I, Wennberg M, Kristoferson
K (1992) Swedish statistics on medicines
1991 (Svensk Lakemedelsstatistik).
Apoteksbolaget, Stockholm.
Smith SM, Fahey T, Smucny J et al (2014)
Antibiotics for acute bronchitis. Cochrane
Database of Systematic Reviews. Issue 3.
CD000245. doi: 10.1002/14651858.CD000245.
pub3.
Smith SM, Fahey T, Smucny J et al (2017)
Antibiotics for acute bronchitis. Cochrane
Database of Systematic Reviews. Issue 6.
CD000245. doi: 10.1002/14651858.CD000245.
pub4.
Verheij TJ, Hermans J, Kaptein AA et al (1990)
Acute bronchitis: general practitioners’ views
regarding diagnosis and treatment. Family
Practice. 7, 3, 175-180.
Wenzel RP, Fowler AA III (2006) Clinical
practice. Acute bronchitis. New England
Journal of Medicine. 355, 20, 2125-2130.

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