Bronchitis, deadly scourge of man – at least, considering the quantity of antibiotics prescribed, it must be, right?
Or, the cure is worse than the disease, as these authors seem to demonstrate. This is a parallel, single-blinded, placebo-controlled trial in 9 primary care centers in Catalonia, Spain, enrolling patients with acute bronchitis. Non-immunosuppressed patients with a productive cough of less than a week’s duration were randomized to amoxicillin-clavulanic acid, ibuprofen, or placebo for a 10 day course. The primary outcome was time to cure, with treatment failure and safety outcomes as secondary outcomes.
With approximately 140 patients in each group, the only clinically meaningful significant difference between groups was the incidence of adverse events in the amoxicillin-clavulanic acid group. These were mostly gastrointestinal events, occurring in 12% of the antibiotic group, compared with 5% of the ibuprofen group and 3% of the placebo group. Days with cough, treatment failure, and time to overall symptom resolution showed no significant differences between groups. There was some suggestion of a trend towards benefit from the ibuprofen arm, but this would have to be confirmed in a larger trial.
The main limitation of this article is failure to include a macrolide antibiotic as a comparator, considering the expected bacterial epidemiology of ambulatory respiratory infections. Regardless, this adds to the body of evidence demonstrating the futility of antibiotics in healthy patients with bronchitis – and I’d expect similar findings even if azithromycin were included.
“Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial”
www.ncbi.nlm.nih.gov/pubmed/24097128