Antibiotics Useless for Bronchitis

BySIRI NILSSON<br>ABC NEWS Medical Unit</br>

Nov. 16, 2006 &#151; -- Cold and cough season is upon us.

If you have a lingering cough caused by bronchitis, though, a new study suggests that antibiotics won't do a thing to help.

Antibiotics are often prescribed for treatment of bronchitis, but the drugs are hardly a help to patients.

Bronchitis is 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.

Even though antibiotics are no match for bronchitis-causing viruses, 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.

Furthermore, the review finds that nearly 100 percent of bronchitis patients also get a prescription for cough medication even they are also pretty useless.

Not only are the medications useless, they can actually do harm.

Researchers say taking antibiotics for this type of cough will give you all of the side effects and none of the relief that a patient might want from the medication.

These drugs simply don't work on viruses, but the drugs may 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 methicillin resistant staphylococcus aureus (MRSA).

Taking an antibiotic isn't at all like taking, say, a vitamin. This commonly prescribed class of medications has a very real effect on the body's immune system.

Most doctors say the best remedy for this kind of cough includes fluids, a humidifier, and an over-the-counter medication if you have a fever.

So, why do many of these same doctors still give patients prescriptions for useless antibiotics?

Doctors still give drugs that don't help in part because patients demand them, but many doctors say this isn't the patient's fault -- they have actually trained patients, in a sense, to expect antibiotics.

It's sort of a vicious cycle.

Doctors continue to prescribe useless antibiotics because patients continue to expect them, and patients continue to expect the antibiotics because doctors continue to prescribe them.

"This is a battle young primary-care doctors fight with their patients every day," said San Antonio-based Dr. Carolyn Eaton.

Eventually, some doctors just don't have time to fight the battle anymore.

"Most just are in too much of a rush to explain to patients why they don't need an antibiotic, and hand the patient a prescription for antibiotics so they can get out the door and on to the next patient," Eaton said. "Is this dangerous? Very much so. Medications have inherent risks."

Despite the danger, does it happen? Yes, it does.

But, again, why do doctors still give patients prescriptions for antibiotics in cases where studies have shown the drugs to be ineffective?

It may be for the simple reason that patients see a doctor with hopes that their illness will be fixed.

"Most times, what people really want is an answer as to what they have, reassurance that it is not going to kill or disable them, and symptom relief," said Dr. Richard Roberts, professor of family medicine at the University of Wisconsin Medical School in Madison, Wis.

Perhaps a prescription is a crude proof-of-repair service.

It's like your mechanic. Your mechanic says, "Your radiator is leaking fluid," and then fixes the leak. The mechanic wouldn't not fix the leak.

On the other hand, a doctor might say, "Your cough is due to a lingering virus," but not fix the virus, because, scientific studies have shown, time and time again that antibiotics won't make that virus go away.

Most doctors agree that if patients get a reasoned explanation, they will agreeably leave the office empty-handed, if that's medically appropriate.

Patients should instead save the medications for times when the drugs are really needed.

"While there are a few who are insistent about antibiotics, most seem persuaded if you take the time to talk with them -- to defer antibiotics until they are feeling or doing worse," Roberts said.

As this study suggests, a prescription won't always make minor illnesses go away. Unnecessary prescriptions could create more problems.

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