Clinical features and treatment of acute bronchitis

Although several surveys rank acute bronchitis as one of the ten most frequent diagnoses made by primary care physicians, its clinical features are poorly defined and treatment with antibiotics is controversial. This study was designed to determine the clinical characteristics that providers use to diagnose acute bronchitis and to examine the use of antibiotics in treating this illness. Charts of patients with the diagnosis of acute bronchitis or upper respiratory tract infection (URI) were randomly selected and progress notes from these visits were reviewed. Signs, symptoms, laboratory tests, and antibiotics prescribed were recorded. Patients with a diagnosis of acute bronchitis had more productive cough, purulent sputum, and abnormal lung examinations than patients with a diagnosis of URI (P less than .05 for each characteristic). Laboratory tests, including chest roentgenograms, were not frequently used in making the diagnosis of acute bronchitis. Antibotics were prescribed for 27 of 29 patients (92 percent) with a diagnosis of acute bronchitis but for only 4 of 19 patients (21 percent) with a diagnosis of URI. Erythromycin was prescribed for 60 percent of patients with acute bronchitis. From this study it can be concluded that providers use the term acute bronchitis to designate a specific clinical syndrome that they treat with antibiotics. Further clinical trials are needed to evaluate the efficacy of such antibiotic therapy.