FACTORS ASSOCIATED WITH ANTIBIOTIC USE FOR ACUTE BRONCHITIS

OBJECTIVES: To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis. DESIGN: Prospective, cohort study. SETTING: Primary care office practices at a group-model HMO in the Denver metropolitan area. PATIENTS/PARTICIPANTS: Patients were adu lts seeking care for acute respiratory illnesses. Participating clinic ians included internists, family medicine physicians, nurse practition ers, physician assistants, and registered nurses. MEASUREMENTS AND MAI N RESULTS: Clinicians voluntarily completed encounter forms for patien ts presenting with acute respiratory illnesses between February and Ma y, 1996. Acute bronchitis was the primary diagnosis in 16% of acute re spiratory illness visits (n = 1,525), The most frequent symptoms of ac ute bronchitis were cough (92%), phlegm production (63%), ''runny nose '' (50%), and throat pain (50%), The most frequent physical examinatio n findings were pharyngeal erythema (45%), cervical lymphadenopathy (1 9%), wheezes (18%), and rhonchi (17%). Antibiotics were prescribed to 85% of patients diagnosed with acute bronchitis. Purulent nasal discha rge by patient report, and sinus tenderness on physical examination we re moderately associated with antibiotic treatment (p = .06 and .08, r espectively). Antibiotic prescription rates did not vary by patient ag e or gender, duration of illness, days of work lost due to illness, or clinician type. CONCLUSIONS: Acute bronchitis is frequently treated w ith antibiotics in ambulatory practice. The clinical factors we identi fied to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics fo r this condition. These findings suggest that clinicians use the diagn osis of acute bronchitis as an indication for antibiotic treatment, de spite clinical trials and expert recommendations to the contrary.