| Background |
 |
Greater than 90% of cases of acute cough
illness are non-bacterial. |
| |
Viral etiologies include influenza,
parainfluenza, RSV, and adenovirus. |
| |
Bacterial agents include Bordatella
pertussis, Mycoplasma pneumoniae,
and Chlamydophila pneumoniae. |
|
The presence of purulent sputum is not
predictive of bacterial infection. |
| |
>95% of patients with purulent sputum do
not have pneumonia (J Chron Di 1984;
37:215).
|
| Diagnosis |
|
Evaluation should focus on excluding
severe illness, particularly pneumonia.
|
Clinical Assessment for
Pneumonia |
| Sign |
Abnormal
Finding |
| Fever |
≥38°C |
| Tachypnea |
≥24 breaths/min |
| Tachycardia |
≥100 beats/min |
Evidence of
consolidation
on chest exam |
rales, egophony,
fremitus |
|
|
Consider chest radiograph for patients with any of these findings or cough lasting >3 weeks. |
|
| Treatment |
|
Empiric antibiotic treatment is not indicated for acute bronchitis. |
 |
Meta-analyses of randomized, controlledtrials all concluded that routine antibiotic treatment is not justified (BMJ 1998;316:906; Chest
2006;129:95S-103S). |
|
If influenza therapy is considered, it should be initiated within 48 hours of symptom onset for clinical benefit. |
| |
|
During the 2005-06 Flu recommends that neither amantadine nor rimantadine be used for treatment or prevention of influenza A infections because of high levels of resistance (MMWR 2006 Jan 20;55(2):44-6). |
|
Neuramidase inhibitors such as oseltamivir or zanamivir have activity against influenza A and B viruses. |
| |
|
Antiviral therapy reduces symptom duration
by approximately 1 day.
http://www.cdc.gov/flu/ professionals/treatment/ |
|
If pertussis is suspected, empiric therapy may be initiated while obtaining a diagnostic test for confirmation. |
| |
|
Antibiotic treatment decreases transmission but has little effect on symptom resolution. |
|
Over-the-counter cough suppressants have limited efficacy in relief of cough due to acute bronchitis (Chest 2006; 129:95S-103S). |
|
TIPS TO REDUCE
ANTIBIOTIC USE |
|
Tell patients that antibiotic use increases the risk of an antibiotic resistant infection. |
|
Identify and validate patient concerns. |
|
Recommend specific
symptomatic therapy. |
|
Spend time answering questions and offer a contingency plan if symptoms worsen. |
|
Provide patient education materials on antibiotic resistance. |
|
REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction. |
|
See www.cdc.gov/
drugresistance/
community or contact your local health department for more information and patient education materials. |
|
Key Reference
Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17. |
|
