[Approach of acute bronchitis in general practice]

Acute bronchitis is a frequent infection in general practice. Its origin is usually viral, but frequently, antibiotics are prescribed in this situation, without any clinical benefit. There are several reasons for this, the most important is probably the difficulty of GP's to distinguish on clinical ground alone between "viral type, meaning spontaneously healing ", and "bacterial type, meaning potentially dangerous" acute respiratory infections. The emergence of bacteria resistant to antibiotics is defined by the W.H.O. as a major problem of public health. One of the most important measures is the diminution of antibiotic prescriptions. The approach outlined here will help this purpose. The combination of four clinical parameters (fever <38 degrees C, heart rate <100', respiratory rate <24' and a normal auscultation) will allow to avoid the prescription of antibiotics, this constellation in acute bronchitis being sufficiently characteristic of "a viral type" of infection. In case of doubt, the measurement of the CRP, allows to avoid antibiotics if the value is normal (or slightly elevated). This approach is valuable in adults with an otherwise normal health, outside severe chronic illness (which could weaken immunity) and for adults <65 years of age.