More than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result. Responsible use of antibiotics is critical now more than ever, yet nearly one-third of antibiotics prescribed each year in the outpatient and emergency department (ED) setting are unnecessary. One of the opportunities to reduce antibiotic prescribing is in acute bronchitis. Acute bronchitis has a viral etiology primarily and antibiotics are not recommended in healthy, uncomplicated adults. Since 1993, the literature supports no benefit with antibiotic treatment in patients with acute bronchitis. There are risks associated with inappropriate use of antibiotics, such as adverse events, antibiotic resistance, and treatment failure. Adverse events associated with systemic antibiotics for any indication leads to an estimated 142,500 ED visits each year. Despite the evidence for not using antibiotics and the risks, studies have shown antibiotics are prescribed 60–70% of the time for acute bronchitis. Specifically, Ong et al. found that 69% of patients in the ED received antibiotics for acute bronchitis. In efforts to decrease inappropriate antibiotic use, there is a national Healthcare Effectiveness Data and Information Set (HEDIS) measure that “assesses adults 18 to 64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription in which a higher rate is better”. HEDIS scores are important because health payers use the scores for value-based care reimbursement. This measure also provides a criterion that excludes patients from the assessment. For example, if a patient who has a chronic lung disease presents with acute bronchitis, a prescriber can deem antibiotics necessary for treatment and will not be penalized. The literature focuses primarily on identifying patterns of inappropriate prescribing behaviors and testing interventions to improve appropriate antibiotic prescribing for acute bronchitis. To our knowledge, there are no previous randomized studies assessing the impact of antibiotic use in acute bronchitis on ED returns and hospital admissions. In 2017, in the United States, more than 1.4 million people presented to the ED with acute bronchitis. With the average cost of an ED visit being $1917, examining the impact on ED returns provides an outcome of great interest for both patients and health care systems. The purpose of this study was to compare hospital return rates between those who were prescribed an antibiotic vs. those who were not prescribed an antibiotic for treatment of acute bronchitis. Our findings suggest that prescribing antibiotics for acute bronchitis does not prevent hospital returns. This is consistent with previous studies that found no difference in clinical improvement among patients who were treated with antibiotics or placebo for acute bronchitis. In fact, patients who received antibiotics had an increase in adverse drug events. For every 24 patients treated with antibiotics, 1 patient had an adverse drug event. This retrospective cohort study found that rates of ED returns and hospitalizations were similar in patients who did not receive an antibiotic compared with those who did receive an antibiotic. Further prospective studies are needed to prove this correlation is due to the patient not receiving an antibiotic. Of note, more than one-half of the patients who were not prescribed antibiotics would have qualified for treatment per the current high-risk HEDIS exclusion criteria.

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Regards,
Catherine 
Journal Co-Ordinator
Journal of Clinical Immunology and Alergy