Abstract
OBJECTIVE: Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis.
DESIGN: A medline search was done using the keywords bronchitis, cough, and antibiotics to identify English language articles published from January 1966 to September 2001. Randomized, placebo-controlled trials of antibiotics in previously healthy smokers and nonsmokers with acute bronchitis were included.
MEASUREMENTS AND MAIN RESULTS: For each study, we abstracted information on design, size, inclusion criteria, patient characteristics, and outcomes. Of 2,029 articles in the original search, 109 relevant articles were retrieved and reviewed. There have been no studies specifically addressing antibiotic use in smokers with acute bronchitis. Nine randomized, placebo-controlled trials of antibiotics have included 774 patients and over 276 smokers. Lack of subgroup reporting for smokers precluded meta-analysis. In 7 trials, smoking status did not predict or alter patients’ response to antibiotics. In one trial, trimethoprim/sulfamethoxazole resulted in less-frequent cough overall, but not among smokers. In another trial, erythromycin reduced symptom scores only among nonsmokers while antibiotic-treated smokers had a trend toward higher symptom scores.
CONCLUSION: Although no trials have specifically addressed antibiotic use in smokers with acute bronchitis, existing data suggest that any benefit of antibiotics is the same or less for smokers than for nonsmokers.
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References
Fahey T, Stocks N, Thomas T. Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ. 1998;316:906–10.
Mainous AG, Zoorob RJ, Hueston WJ. Current management of acute bronchitis in ambulatory care: The use of antibiotics and bronchodilators. Arch Fam Med. 1996;5:79–83.
Metlay JP, Stafford RS, Singer DE. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Arch Intern Med. 1998;158:1813–8.
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–4.
Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281:1512–9.
Bent S, Saint S, Vittinghoff E, Grady D. Antibiotics in acute bronchitis: a meta-analysis. Am J Med. 1999;107:62–7.
Smucny J, Fahey T, Becker L. Antibiotics for acute bronchitis (Cochrane Review). The Cochrane Library, Issue 2. Oxford: Update Software; 2001.
Oeffinger KC, Snell LM, Foster BM, Panico KG, Archer RK. Treatment of acute bronchitis in adults. A national survey of family physicians. J Fam Pract. 1998;46:469–75.
Dosh SA, Hickner JM, Mainous AG III, Ebell MH. Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis. An UPRNet study. Upper Peninsula Research Network. J Fam Pract. 2000;49:407–14.
Gwaltney JM. Acute bronchitis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Vol. 1. New York: Churchill Livingstone; 1995:606–8.
Hueston WJ, Mainous AG III. Acute bronchitis. Am Fam Physician. 1998;57:1270–6, 1281–2.
Orr PH, Scherer K, Macdonald A, Moffatt ME. Randomized placebocontrolled trials of antibiotics for acute bronchitis: a critical review of the literature. J Fam Pract. 1993;36:507–12.
MacKay DN. Treatment of acute bronchitis in adults without underlying lung disease. J Gen Intern Med. 1996;11:557–62.
Brauer JE, Bleecker ER. Acute Bronchitis: How—and whether—to prescribe antibiotics. Consultant. May, 1999:1333–40.
Vincenza S, Mottur-Pilson C, Gonzales R. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. 2001;134:518–20.
Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis. Background. Ann Intern Med. 2001;134:521–9.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
Stott NC, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. BMJ. 1976;2:556–9.
Franks P, Gleiner JA. The treatment of acute bronchitis with trimethoprim and sulfamethoxazole. J Fam Pract. 1984;19:185–90.
Williamson HA Jr. A randomized, controlled trial of doxycycline in the treatment of acute bronchitis. J Fam Pract. 1984;19:481–6.
Brickfield FX, Carter WH, Johnson RE. Erythromycin in the treatment of acute bronchitis in a community practice. J Fam Pract. 1986;23:119–22.
Dunlay J, Reinhardt R, Roi LD. A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis. J Fam Pract. 1987;25:137–41.
Scherl ER, Riegler SL, Cooper JK. Doxycycline in acute bronchitis: a randomized double-blind trial. J Ky Med Assoc. 1987;85:539–41.
Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract. 1994;39:437–40.
Verheij TJ, Hermans J, Mulder JD. Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial. Br J Gen Pract. 1994;44:400–4.
King DE, Williams WC, Bishop L, Shechter A. Effectiveness of erythromycin in the treatment of acute bronchitis. J Fam Pract. 1996;42:601–5.
Saint S, Bent S, Vittinghoff E, Grady D. Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA. 1995;273:957–60.
Hueston WJ. A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract. 1991;33:476–80.
Melbye H, Aasebo U, Straume B. Symptomatic effect of inhaled fenoterol in acute bronchitis: a placebo-controlled double-blind study. Fam Pract. 1991;8:216–22.
Smucny J, Flynn C, Becker L, Glazier R. Beta2-agonists for acute bronchitis (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software; 2001.
Howie JG, Clark GA. Double-blind trial of early demethylchlortetracycline in minor respiratory illness in general practice. Lancet. 1970;2:1099–102.
Jónsson JS, Gíslason T, Gíslason D, Sigurdsson JA. Acute bronchitis and clinical outcome three years later: prospective cohort study. BMJ. 1998;317:1433.
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Dr. Linder was supported by National Research Service Award 5T32PE11001-12.
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Linder, J.A., Sim, I. Antibiotic treatment of acute bronchitis in smokers. J GEN INTERN MED 17, 230–234 (2002). https://doi.org/10.1046/j.1525-1497.2002.10405.x
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DOI: https://doi.org/10.1046/j.1525-1497.2002.10405.x