Acute Bronchitis Literature Review

1. Introduction
Antimicrobial resistance has emerged as looming threat to public health. The misuse of antibiotics is implicated as a major cause of resistant strains. Scientists are thus advocating for antibiotic stewardship in all health care facilities. In order to implement campaigns on appropriate antibiotic usage, it is essential to understand the factors influencing inappropriate and inaccurate antibiotic prescription. This literature review thus examines the possible reasons for practitioners to deviate from the standard treatment guidelines in acute upper respiratory tract infections (AURTIs).

2. Current Guidelines on Antibiotic Usage

Systematic review indicates that antibiotics are ineffective in the treatment of AUTRIs and furthermore

One such cross-sectional study in Eastern France indicated that only 36.5% of practitioners adhered with stipulated guidelines regarding antibiotic prescription in the treatment of acute bronchitis. (pink). There are two major areas of concern with regards to treatment of AURTIs: inappropriate prescription of antibiotic in non-bacterial clinical picture and inaccurate prescription of the dosage, duration and choice of antibiotic in cases where it is

This was reflected in a study from 16 clinics in Turkey which revealed inadequate antibiotic prescription in 137 out of 461 cases (29.7%).

4.1 Choice of Drug and Polypharmacy

Two classes of antimicrobial medication are available for treatment of bacterial infection viz. broad- and narrow-spectrum antibiotics. While research recommends narrow-spectrum drugs for uncomplicated bacterial infections, broad-spectrum antibiotics are commonly used, as seen in a retrospective cohort study where over half of AURTIs (and specifically 68% of acute bronchitis cases) were treated with broad-spectrum antibiotics. Although the intention may be to increase rate of recovery, this also increases propensity for resistance. (green highlighter)

It is interesting that antimicrobials are often not prescribed in isolation, with all patients who received an antibiotic for an AURTI receiving at least one other drug (antipyretic, antitussive or antihistamine) from the clinic. This polypharmacy can result in adverse drug interactions and the associated increased pill count can decrease