Rethinking the anti-antibiotic dogma

A while back I linked a study demonstrating that antibiotics, when prescribed for bronchitis, prevented pneumonia. Now comes this study in Chest showing that antibiotic treatment in the ambulatory setting for “lower respiratory tract infections” (essentially bronchitis) is associated with decreased mortality and decreased hospitalization rates. An accompanying editorial points out the methodologic problems, suggests alternative explanations for the findings and calls for more research.

What does it mean? That a rigid rule against antibiotics for bronchitis is simplistic. Consider the patient you’re dealing with. Some healthy patients at low risk can probably do without. On the other hand prior research has shown that when bronchitis is causing a COPD exacerbation antibiotics may be life saving. Think before you give antibiotics to patients with bronchitis. Equally important, think before you withhold them!