Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: Background (reprinted from Annals of Internal Med, March 20, 2001)

The following principles of appropriate antibiotic use for adults with acut e bronchitis apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease. 1. The evaluation of adults with an acute cough illness or a presumptive di agnosis of uncomplicated acute bronchitis should focus on ruling out seriou s illness, particularly pneumonia. In healthy, nonelderly adults, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lun g sounds, and chest radiography is usually not indicated. In patients with cough lasting 3 weeks or longer, chest radiography may be warranted in the absence of other known causes. 2. Routine antibiotic treatment of uncomplicated acute bronchitis is not re commended, regardless of duration of cough. If pertussis infection is suspe cted (an unusual circumstance), a diagnostic test should be performed and a ntimicrobial therapy initiated. 3. Patient satisfaction with care for acute bronchitis depends most on phys ician-patient communication rather than on antibiotic treatment.