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Taking antibiotics for acute bronchitis didn’t improve the severity of cough or how long it lasted, even if the cough was caused by a bacterial rather than a viral infection, according to a study published on April 15 in the Journal of General Internal Medicine .e60dc2a1-f33c-4a05-9b50-8e3e8e597629182dfbca-c7bf-4da0-8690-066652fd7a02 These findings add further support to the current recommendation, which is not to give antibiotics to people with acute bronchitis who are generally healthy and not at high risk for severe illness, says Jennifer Pisano, MD , an associate professor of medicine at UChicago Medicine and medical director of the Antimicrobial Stewardship and Infection Control. “This study should help providers feel confident in following the guidelines, even in the small percentage of bronchitis cases caused by bacteria,” says Dr. Pisano, who was not involved in the study. Cough Sends People to the Doctor More Than Any Other Symptom Cough is the most common illness-related reason for a doctor’s visit, accounting for nearly three million outpatient visits and more than four million emergency department visits annually, says lead author Dan Merenstein, MD , a professor of family medicine at Georgetown University School of Medicine in Washington, DC, in a press release.e60dc2a1-f33c-4a05-9b50-8e3e8e597629aecc8da5-dc20-4bac-8e49-7dd1dddf31b5 RELATED: 10 Tips for Day and Night Cough Relief “Upper-respiratory tract infections usually include the common cold, sore throat, sinus infections, and ear infections, and have well-established ways to determine if antibiotics should be given,” said Dr. Merenstein. Viruses cause colds and flu, as well as most sore throats and coughs — and antibiotics can’t kill viruses. Bacteria causes most ear infections, some sinus infections, UTIs, and strep throat, and for those illnesses, doctors can determine if and what type of antibiotic may be used.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a7a3a5b-8dd5-4838-adf5-13b5fc5b7835 About 30 Percent of People With Cough Were Prescribed an Antibiotic This study looked at people with lower-respiratory tract infections, also called acute bronchitis, which affect the airways and usually causes a deep, lingering cough and fever.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f721e4f-c3b8-4e41-9516-44cf885a3053 Lower-respiratory tract infections tend to have the potential to be more dangerous, since about 3 to 5 percent of these patients have pneumonia , said Merenstein. Pneumonia is when the infection travels further into the lungs. The observational study included over 700 people between the ages of 18 and 75 years old who came to their primary care doctor or urgent care between June 2019 and April 2023 with acute bronchitis. The average age was 39, and about 3 out of 4 people had a moderately bad cough or worse. Participants reported having a cough for five days on average before their doctor visit. Overall, 29 percent of patients received at least one antibiotic — and all antibiotics prescribed were appropriate and commonly used antibiotics used to treat bacterial infections; 7.1 percent received an antiviral agent. People With More Severe Symptoms Were More Likely to Get an Antibiotic People prescribed an antibiotic were significantly more likely to have a moderate to severe cough, colored phlegm, a stuffy or runny nose, wheezing, and fatigue compared with people who did not get one. Those with a cough that caused shortness of breath, ligh-theadedness, nausea, or vomiting were also more likely to receive an antibiotic. The severity of cough was recorded at baseline and on days 3, 7, 14, 21, and 28 via a text linked to an online survey. While patients expected that their duration of cough would be shortened by four days if they received an antibiotic, the results showed that those who were prescribed an antibiotic actually had their cough for a day and a half longer compared with those who didn’t get prescribed an antibiotic (17.5 versus 15.9 days). This increase likely didn’t have anything to do with the antibiotics, but rather was “largely due to patients with a longer duration of illness prior to the index visit being more likely to receive an antibiotic,” the researchers wrote. To determine if there was an actual bacterial or viral infection present, beyond the self-reported symptoms of a cough, the investigators confirmed the presence of pathogens (germs) with advanced lab tests to look for microbiologic results classified as only bacteria, only viruses, both virus and bacteria, or no bad germs detected. Antibiotics Didn’t Help — Even When the Cough Was Caused by Bacteria and Not a Virus Even for the 40 people who had a bacterial germ detected on PCR tests, the duration of cough was the same, 17 days, whether or not an antibiotic was prescribed. Is it surprising that antibiotics didn’t help improve cough, even when it was a bacteria-caused infection? “The findings are a little surprising, but maybe they shouldn’t be,” says Pisano. After all, the majority of respiratory infections in primary care (outside of the hospital) are managed without knowing if a virus versus bacteria causes it, she says. “Providers, even though well intended, may prescribe antibiotics out of fear of missing a bacterial infection that could lead to a worse outcome based on older age or worse symptoms, and this study gives us data that should help decrease those fears,” says Pisano. Antibiotics may not help improve the symptoms of a bacterial infection because symptoms may be more related to the immune system’s response in fighting the infection than specific to the pathogen, bacterial or viral, she says. People at Higher Risk for Severe Disease May Need an Antibiotic for Acute Bronchitis Most adults who have a healthy immune system and good lung function are able to fight common viruses and bacteria that cause lower respiratory tract infections, and that may be why antibiotics did not change the duration of symptoms or outcomes. “It is important to note that anyone high-risk for severe illness was excluded,” she says. People who are at higher risk would include people with reduced immune system or lung function, and they may need antibiotics for this type of infection. Their primary care provider would advise them if this was necessary, says Paul Pottinger, MD , an infectious disease doctor at UW Medicine in Seattle, who was not involved in this study. Rather than prescribe antibiotics to healthy adults, providers need to help set expectations for patients regarding how quickly (or slowly) they will recover from a lower respiratory tract infection. “That may increase a patient’s confidence that what they are experiencing is expected and does not require treatment with antibiotics,” says Pisano. Why It’s Bad to Take Antibiotics When You Don’t Need Them Taking antibiotics when you don’t need them isn’t recommended for a few reasons, says Dr. Pottinger. Just like any medication, antibiotics can cause side effects. The most common side effects of antibiotics include nausea, diarrhea, and allergic reactions.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d0227724-501a-4a16-a486-5ad169b6b54b There’s also evidence that antibiotics can adversely impact gut health and reduce microbiome diversity.e60dc2a1-f33c-4a05-9b50-8e3e8e597629570c699a-c92e-4889-9330-ce716eafec62 Another significant concern of the overuse of antibiotics is resistance. The World Health Organization considers antimicrobial resistance to be a top world health issue, and it’s a leading cause of death globally.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f0c27ff2-899e-4475-b1da-7de432a73c5f Prevention of Infection May Be the Best Medicine How can people avoid these infections in the first place? Pottinger offers these top tips: If you smoke or vape, talk with your provider about strategies, medications, or online resources to help you stop.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a28a9206-3fcb-45bd-bc4f-4715803a5c06 Both smoking and vaping are huge risk factors for these infections, he says. Stay up to date on your immunizations. It’s one of the best ways to stay healthy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab1f4ea1-d2e4-4e8c-9f75-7d0819bbbdf9 Avoid people who are sick. “If you’re around someone who’s coughing, sneezing, everyone try to get away from them because those infections do tend to spread,” says Pottinger.

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