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去看全科医生的最常见原因之一。这可能会对患者的生活产生相当大的影响，患者平均咳嗽两周，三分之一的患者在床上休息一段时间，四分之一的患者在数周内无法恢复正常活动。如果他们去看全科医生，他们很可能会接受抗生素治疗。但研究人员认为，这种情况下抗生素处方过多，细菌耐药性的出现是卫生当局真正担心的问题。因此，全科医生被敦促减少对这种常见疾病的抗生素处方。但国家新闻服务(NPS)的调查表明，这是全科医生发现很难达到国家建议的一个领域。这在一定程度上可能是因为全科医生不希望低估或错过严重的呼吸道疾病。此外，检验抗生素对急性支气管炎有效性的随机对照试验的结果表明，至少在一些患者中，抗生素治疗有一些好处。然而，目前还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，他们随后选择为所有出现急性支气管炎的人开一张“以防万一的处方”。我们的研究将重新检查向全科医生报告的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。我们将确定谁能从抗生素中受益，谁不能从抗生素中受益，并就预测较差结果的症状、临床结果和调查向全科医生提供指导。这项研究的证据将纳入急性支气管炎的治疗指南，从而更合理和有效地处理这一常见问题。

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.