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Alert Number 202

Bronchitis: Don't Reach for the Antibiotics

Date: November 17, 2006

It is that time of the year again.

No, I am not talking about turkey dinner or Christmas eggnog.  I am talking about bronchitis, a type of inflammation that causes coughing, wheezing and possibly fever. It hits about 5 percent of adults in the United States every year. Most cases aren't serious and eventually go away on their own. Since we are specially blessed with CLL, it may take us a little while longer to get rid of the bug.

Antibiotics are often prescribed for treatment of bronchitis. Bronchitis is caused by viruses, and antibiotics don’t work on viruses.  Since CLL patients are more likely to have compromised T-cell function, either due to the cancer itself or the drugs used to treat the CLL, and T-cells are our number one defense against viral infections, we are more at risk of getting bronchitis and its attending complications.  A new review published in this week's New England Journal of Medicine reports that 70 percent to 80 percent of people with bronchitis are still prescribed antibiotics by their doctors.  The review also finds that nearly 100 percent of bronchitis patients also get a prescription for cough medication, and this is equally useless.

Not only are antibiotics useless in treating bronchitis, they can actually do harm.  Taking antibiotics for typical bronchitis will give you all of the side effects and none of the relief that a patient might want from the drugs.   Antibiotics simply don't work on viruses, but their use will most likely add stomach pain, diarrhea and rashes to an already bothersome cough.  Antibiotic overuse can also lead to antibiotic resistant bacterial infections — such as the potentially fatal MRSA (methicillin resistant staphylococcus aureus).  We have published a recent article on the very real danger of life-threatening MRSA infections.

Infections: Who is most at risk?

Super bugs: MRSA

What to do?

  1. It is important to have a realistic assessment of your level of risk.  If you are a patient with late stage CLL, and you have had most chemotherapy known to man, especially drugs such as Campath and fludarabine that are toxic to T-cells, you are clearly at higher risk of infections and need to be extra careful. 
  2. The opposite is true for newly diagnosed or early stage patients.  The first link above will give you some idea of how to judge your exposure. 
  3. Prevention is the best method of dealing with bronchitis.  Use commonsense precautions: avoid people with hacking coughs (even when they are the cutest of cute grandkids!) If you are particularly prone to bronchitis, try to stay away from crowed places, airports, airplanes etc. 
  4. Keep a small bottle of disinfecting alcohol gel with you at all times, and use it often.
  5. Last but not least, if you do get bronchitis, try to ride it out with plenty of rest and lots of fluids, and don’t bug your GP for antibiotics.  These are bullets that you want to save, for sometime in the future when you may really need them.  Overuse of antibiotics may leave you holding the bag with some super-bug or the other.

Be well,


Journal Article:

Scientific American
November 15, 2006
By Will Dunham

Antibiotics usually useless for bronchitis: study

WASHINGTON (Reuters) - There is no evidence antibiotics help the vast majority of patients with acute bronchitis, and doctors should stop routinely prescribing them, researchers reported on Wednesday.

Acute bronchitis, an inflammation of the main airways to the lungs marked by an irritating cough, is one of the most common conditions treated by primary-care doctors, occurring in about 5 percent of adults each year.

Two Virginia Commonwealth University doctors, writing in the New England Journal of Medicine, said an exhaustive review of existing research studies and clinical trials turned up no evidence to support prescribing antibiotics for short-term bronchitis.  This is because, they stated, almost all cases are viral infections and do not respond to antibiotics.  They also found little evidence that cough medicine, also prescribed in most acute bronchitis cases, had any value.

Dr. Richard Wenzel, chairman of the Department of Internal Medicine at VCU's School of Medicine, said doctors prescribe antibiotics to 70 percent to 80 percent of patients with acute bronchitis for treatment lasting 5-10 days.  Wenzel said doctors generally should send home patients with acute bronchitis empty handed. Wenzel estimated that only a few percent of acute bronchitis cases might have a bacterial cause necessitating antibiotics.  Doctors say most cases will go away on their own after a few days or a week, and recommend rest and drinking lots of fluids.


"We think that for the most part antibiotics are not needed," Wenzel said in an interview.

Wenzel, who wrote the paper with VCU colleague Dr. Alpha Fowler, said he had several concerns about the routine prescription of antibiotics in these cases, aside from the fact they do not help most acute bronchitis patients.

Wenzel cited the cost of the many millions of pointless doses of the antibiotics as well as side effects from antibiotics such as diarrhea, gastric upset, rash, headaches and muscle aches.

Wenzel said the unnecessary prescriptions also contribute to the problem of bacteria becoming resistant to antibiotics, thus rendering them less useful for treatment of infections.

"I hope that doctors will pause ... and spend a few minutes to say (to patients) why it's unnecessary to take an antibiotic," Wenzel added.  "Now I know that I'm floating against the pressures of managed care to move people through. And sometimes I sort of see the obvious -- what's easier for a physician: take 30 seconds to write a prescription, or take five or 10 minutes to say why you don't need one?" Wenzel said.

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