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Antibiotics are prescribed commonly for acute bronchitis, and nonsteroidal anti-inflammatory drugs are prescribed commonly for fever or discomfort that can accompany respiratory illnesses. In this multicenter randomized trial, investigators in Spain compared amoxicillin-clavulanate or ibuprofen with placebo in 416 adults with uncomplicated acute bronchitis (<7 days duration with cough as the main symptom), discolored sputum, and ≥1 additional respiratory symptom (e.g., dyspnea, chest discomfort).
The groups did not differ in median number of days with frequent cough (≈9 days) or days with any symptoms (≈10 days). Adjusted for multiple variables, neither amoxicillin-clavulanate nor ibuprofen was associated with greater likelihood of cough resolution than was placebo. However, adverse effects (e.g., gastrointestinal discomfort) were significantly more common in the amoxicillin-clavulanate group (12%) than in the ibuprofen (5%) and placebo (3%) groups.
Llor C et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: Randomised placebo controlled trial. BMJ 2013 Oct 4; 347:f5762. (http://dx.doi.org/10.1136/bmj.f5762)
Comment
Because most cases of uncomplicated acute bronchitis are caused by viral infections, it is not surprising that amoxicillin-clavulanate was no better than placebo. Indeed, these results affirm that antibiotics should be not used in affected patients. However, I am surprised that ibuprofen was no better than placebo, given the inflammatory aspects of acute bronchitis. The authors rightfully claim that we need to identify novel treatments to deal with this common disease.