Acute bronchitis in general practice: what factors predict a poor outcome and can antibiotics help?

在澳大利亚，急性支气管炎是患者参加全科医生的最常见原因之一。它可能对患者的生活产生相当大的影响，患者平均咳嗽两周，三分之一的人在床上呆了一段时间，四分之一的人在许多周内没有恢复日常活动。如果他们参加全科医生（GP），他们可能会接受抗生素。但研究人员认为，抗生素是过度规定这种情况和细菌耐药性的出现是一个真实的关注卫生当局。因此，敦促全科医生减少这种常见疾病的处方药。但是国家处方服务中心（National Prescribing Service）的调查表明，这是全科医生发现难以满足国家建议的一个领域。部分原因可能是因为全科医生不希望治疗不足或错过严重的呼吸道疾病。此外，随机对照试验的结果表明，抗生素对急性支气管炎的有效性表明，至少在一些患者中，治疗是有益的。然而，目前尚不清楚这些患者是谁，以及他们将从接受抗生素中获得多少好处。这给全科医生带来了很大的不确定性，他们随后选择为每个急性支气管炎患者开“以防万一”的处方。我们的研究将重新检查急性咳嗽患者的症状和临床表现，并探讨这种常见疾病对患者生活的影响。我们将确定谁受益于抗生素，谁不受益于抗生素，并向全科医生提供有关症状，临床发现和预测结果较差的调查的指导。这项研究的证据将被纳入急性支气管炎的治疗指南，从而更合理和有效地管理这一常见问题。

In Australia acute bronchitis is one of the commonest reasons for patients to attend their general practitioner. It can have considerable impact on patients lives with patients coughing on average for two weeks, with a third spending some time in bed and a quarter not returning to their usual activities for many weeks. If they attend a general practitioner (GP) it is likely they will receive antibiotics. But researchers believe that antibiotics are over prescribed for this condition and the emergence of bacterial resistance is a real concern to health authorities. GPs are therefore being urged to reduce the prescription of antibioics for this common condition. But surveys by the National Prescribing Service (NPS) indicate that this is one area where GPs find it difficult to meet national recommendations. In part this may be because GPs do not wish to undertreat or miss a serious respiratory illness. Also results from randomised controlled trials examining the effectiveness of antibiotics for acute bronchitis suggest some benefit from treatment, at least in some patients. However it is not clear who these patients are and how much benefit they would get from receiving antibiotics. This creates a great deal of uncertainity for GPs who then opt for a 'just in case prescription' for everyone presenting with acute bronchitis. Our study will re-examine the symptoms, and clinical findings of patients presenting to their GP with acute cough and explore the impact of this common illness on patients lives. We will determine who does and does not benefit from antibiotics, and give guidance to GPs about the symptoms, clinical findings and investigations that predict a poorer outcome. Evidence from this study will be incorporated into treatment guidelines for acute bronchitis leading to more rational and effective management of this common problem.