Bronchitis or else?
April 13, 2011 1:07 PM   Subscribe

YANAD etcetc but I've had a nasty cough for 3 weeks. Finally I went to the doctor. After a 4 minute auscultation, he said I have bronchitis and he prescribed antibiotics.

Of course I googled, and apparently bronchitis is viral so antibiotics shouldn't be prescribed. Is my doctor an ass or do I have pneumonia and he didn't tell me? I hate antibiotics, esp. if I don't really need them. But I started the cycle yesterday. Can I just ditch them?
posted by uauage to Health & Fitness (33 answers total) 3 users marked this as a favorite
My Mum who's 71 seems to get bronchitis every year and it's always a horrible cough that won't go away, and then it disappears as if by magic one and a half days after she starts the antibiotics.
posted by Dragonness at 1:12 PM on April 13, 2011

My middle name should be bronchitis. Generally, I get it at least twice a winter. There is a bacteria associated with it and usually the z-pack antibiotic is prescribed.

Take the meds or it will turn into pneumonia.
posted by jerseygirl at 1:14 PM on April 13, 2011

Bronchitis can be viral or bacterial.

Bronchitis is an inflammation of the large bronchi (medium-size airways) in the lungs that is usually caused by viruses or bacteria

In short, you have something that is making the tubes in your lungs swell and close/inflame.

Take the antibiotics.
posted by royalsong at 1:16 PM on April 13, 2011 [2 favorites]

I got bronchitis a ton as a kid, and I always got prescribed antibiotics. Frequently, it was a liquid that tasted like bubble gum.
posted by wending my way at 1:16 PM on April 13, 2011

From the mayo clinic's website:

if you take an antibiotic for only a few days — instead of the full course — the antibiotic may wipe out some but not all of the bacteria. The surviving bacteria become more resistant and can be spread to other people. When bacteria become resistant to first line treatments, the risk of complications and death is increased. In the United States alone, thousands of people die each year of antibiotic-resistant infections they contracted in the hospital.

When is it appropriate to use antibiotics?

Antibiotics are effective against bacterial infections, certain fungal infections and some kinds of parasites. Antibiotics don't work against viruses. The chart shows common illnesses and whether they're caused by bacteria or viruses. Taking an antibiotic when you have a viral infection won't make you feel better — and can contribute to antibiotic resistance.

Bacterial infections/Viral infections
Some ear infections
Severe sinus infections
Strep throat
Urinary tract infections
Many wound and skin infections
Most ear infections
Influenza (flu)
Most coughs
Most sore throats
Stomach flu (viral gastroenteritis)
posted by TheBones at 1:21 PM on April 13, 2011 [1 favorite]

Sorry, the formatting didn't take- bronchitis is in the viral column obviously.
posted by TheBones at 1:22 PM on April 13, 2011

According to this NIH site, normal acute bronchitis usually clears up in 7-10 days. So if you're on week 3, they may suspect the accompanying bacterial infection that is also mentioned on the page. (Which was probably my deal as a kid, as NOTHING ever cleared up in 7-10 days for me without antibiotics.)
posted by wending my way at 1:24 PM on April 13, 2011

If your MD prescribed antibiotics, take them. End of story. Yes, there's a chance that he's prescribing them because he thinks many patients will throw a fit if they don't get pills, but that's not your problem and it certainly won't be solved by you skipping the prescription. You solve very little by not taking them, and you might end up in very bad shape if you don't.

Moreover, from wikipedia: "Only about 5–10% of bronchitis cases are caused by a bacterial infection." Maybe you're in that 5-10%. IANAD, YANAD, and it's not up to us to determine that. Take the pills.

Finally, it sounds like you are concerned that you only got an auscultation (hey, I learned a new word toay!). It's my layman's understanding that a really good MD can learn a tremendous about about a patient's condition by taking a careful patient history and performing a physical without relying on any expensive tests. So even though your physician didn't run any labs, don't assume that he's guessing. His clinical acumen and history taking skills may as effective as ordering a test (tests can have false positives and negatives - they're not necessarily more accurate than a physician's knowledge).
posted by Tehhund at 1:24 PM on April 13, 2011

uauage, if your doctor really believes it is bronchitis, he should not typically prescribe antibiotics.

You are right!

A lot of doctors prescribe antibiotics to patients with bronchitis because it takes too long to explain to patients why they don't need antibiotics, and it's much easier just to write the prescription. Plus, antibiotics have been overprescribed for many years, and many people believe that they need antibiotics to get better, even though their infection would probably have gotten better regardless. You can see that in the responses to this thread.

Here is a link that explains when antibiotics are necessary, and why, in most cases, they're not. Thank you for the opportunity for raising awareness!
posted by treehorn+bunny at 1:27 PM on April 13, 2011 [2 favorites]

I've been given antibiotics 2 out of the 3 times I've had bronchitis. Worked great. The 3rd time I was told to come back if it persisted, but it went away on its own. I do have a history of pneumonia - if you do, your doc might be trying to prevent it. Why wouldn't your doctor tell you that you had pneumonia? What would be his or her motivation? If you really want to rule it out, you can get x-rays. But my advice is to chill out and take the rest of the antibiotics.
posted by desjardins at 1:29 PM on April 13, 2011

p.s. you will note in the bronchitis algorithm I linked to, if the cough has been present for >3 weeks, the algorithm suggests considering a different diagnosis.

Of course, being a doctor, I have to add the disclaimer that algorithms are only good up to a point and you still need a doctor to make the final call. :-)
posted by treehorn+bunny at 1:30 PM on April 13, 2011

so, treehorn, do I go on taking them? (I've taken 5 pills so far, 3 a day for two days, minus the one I'm supposed to take right now, and according to the doctor I should take it 6 days).
posted by uauage at 1:40 PM on April 13, 2011

Ack! Don't stop taking them! As TheBones says, stopping mid-way through a course of antibiotics contributes strongly to the creation of superbugs (you've killed only the bacteria with a small protection against the antibiotics, the ones with better protection are still going strong). Even if you are 100% sure that you don't have a bacterial infection (which you're not, see the NIH link from wending my way), you definitely need to finish the course now.
posted by brainmouse at 1:48 PM on April 13, 2011 [2 favorites]

Are you getting better? If so, that is probably because the antibiotics are killing the bacteria that you seem to want to deny exist. If you are halfway through the treatment normally you'd be feeling at least a little better by now. I always have by the time I'm 50% through an antibiotic treatment.
posted by COD at 1:48 PM on April 13, 2011

A lot of doctors prescribe antibiotics to patients with bronchitis because it takes too long to explain to patients why they don't need antibiotics, and it's much easier just to write the prescription.

Is this really still the case? That antibiotics are overprescribed and that they do not work against viruses seems like fairly common knowledge these days.

Are there many ignorant doctors who don't have those facts?

Are there many doctors who are so out of touch that they don't know that WE know those facts?

I just find it hard to believe that very many doctors would continue with such an obviously bad practice--which harms public health--out of the desire not to communicate with their patients.
posted by General Tonic at 1:55 PM on April 13, 2011

Just FYI, but whooping cough in adults often looks/acts like bronchitis. And many doctors are so unused to seeing it that they can miss it. Adults need a pertussis booster, per the CDC.
posted by gsh at 2:02 PM on April 13, 2011

I've always been advised by my doctors that you should complete a course of antibiotics once you start it and that stopping antibiotics early is a contributor to antibiotic resistance.
posted by immlass at 2:16 PM on April 13, 2011

thanks for all your answers. At this point I'll just finish the course of antibiotics. I certainly don't want mutant bacteria. And I'll ask my doctor next time, Why he prescribed antibiotics when he said I had bronchitis.
posted by uauage at 2:20 PM on April 13, 2011

Take the antibiotics already!

Look, antibiotics can be over-prescribed, no question. But if you have had a cough for three weeks now, I would err on the side of this being something aggressive you need to treat. The doctor says take the pills, you have gone through half of them.

If the pills don't work and you have finished taking them all (you do need to give them some time to kick in), there's no real harm done. But if you stop now, you will make the situation WORSE.
posted by misha at 2:22 PM on April 13, 2011

Viral infections usually clear up within a week or two. If it's been more than three weeks, Occam's Razor says it's bacterial. (IANAD, but this is advice from my doctor.) Regardless, once you start taking the antibiotics, you have to take them all.

If you're not better after you finish these antibiotics, call your doctor back at the end of the course. I took back-to-back Z-packs for bronchitis and sinusitis in January, and they made me a lot better but not ALL the way better. I nursed that subclinical infection for a couple months, but then I missed a whole night of sleep when I had to take my baby to the ER because he was struggling to breathe (croup) and I had full-blown pneumonia 36 hours later. I have never been so sick in my life; it's three weeks later and I am still significantly impaired. IOW, lungs? Don't fuck around with them. I narrowly escaped hospitalization.
posted by KathrynT at 2:33 PM on April 13, 2011

All we can do is presume why your doctor prescribed the antibiotics. Not one of us, even the doctors among us, can know the reason.

But you can find out! Call your doctor's office and ask. More realistically, call and leave a message. It will only take two minutes of his day (or his nurse's day) to call you back with an explanation.
posted by m@f at 3:03 PM on April 13, 2011

Yes, once you've started, finish the antibiotics.

Acute bronchitis is nearly always viral and barring complications (e.g., immunocompromised state, COPD), should nearly never be treated with antibiotics. And doctors are seriously TERRIBLE at doing this. The large physician group where I work tends to score exceptionally well per the state's measurement in various domains, and we suck big time when it comes to overprescribing antibiotics for acute bronchitis.

My point is, could be that your doctor was correct in following guidelines re: antibiotic use because of something you did not mention, and it also could be that he is an ass. But he isn't an ass simply for giving antibiotics, as this is a VERY common mis-following of guidelines.
posted by teragram at 3:06 PM on April 13, 2011

I have bronchitis and started antibiotics yesterday. I too wondered if I should start taking them, or wait another week just to see if it's viral, but I went ahead because my sore throat was getting worse. Either it's working are working or the viral version is running it's natural course, but I'm feeling better 24 hours later. Of course I'll finish the Z-pack.

Personally, I think he erred on the side of bacteria based on my inflamed tonsils. I have a history of sore throats because my tonsils are naturally large even when not sore. A doctor peered into my throat last time I had bronchitis 6 years ago and asked me how the hell I swallowed food. (This is in conjunction with my dentist asking me how I chew my food because NONE of my molars touch each other, only my front two teeth). I looked at him with my then twenty-five pounds overweight body and said I have no problems chewing or swallowing food on a daily basis.

Finish the z-pack and feel better. Whatever you do, don't stop taking a course you've already started.
posted by yeti at 3:19 PM on April 13, 2011

If your MD prescribed antibiotics, take them. End of story.

This is an incredibly shortsighted attitude. Please don't treat MDs as infallible and contribute to the problems caused by antibiotic overprescription (bronchitis, by the way, kicks off a section on antibiotic misuse on Wikipedia, with sore throats right behind). You should probably finish the course of antibiotics now that you've started, but next time ask your doctor more questions. If he cannot justify his prescriptions, find someone else.
posted by Behemoth at 3:36 PM on April 13, 2011

Once you started them, you were committed. The person to ask is your doctor. Call the office, and say, "Dr. X prescribed antibiotics for my bronchitis; could you tell me why? My research says it's usually viral." You may, and you should, be a full partner in your care, and you may, and should, expect your doctor to be accountable and to answer your questions.

I appreciate your concern, but your individual use of antibiotics in not a big deal. The big deal is the 100 people your doc prescribes for every month, or the people in countries where antibiotics are available over the counter, or the chicken and beef farms that feed antibiotics to chickens and cows routinely. Your congressperson is a good place to start.

I hope you get better fast.
posted by theora55 at 3:37 PM on April 13, 2011

Old habits die hard. How old is your doctor? Antibiotics were thought essential until fairly recently. Nowadays the linchpin of treatment is prednisone. Most cases will recover with no treatment, however.
posted by neuron at 4:35 PM on April 13, 2011

This is what my doctor told me in February. If anyone wants to disprove it, that's fine by me.

She said they used to prescribe antibiotics for bronchitis all the time, and that the antibiotics worked. But they worked, she said, because they have anti-inflammatory properties. Now, she says, the thinking is to just prescribe the anti-inflammatory thing and skip the antibiotics in order to reduce the problem of drug-resistant bacteria. So, when I had bronchitis, she gave me couple of inhalers.

I can't say that I healed faster than I would have on antibiotics, but it made a lot of sense to me since I was pretty sure I had a virus and not a bacterial infection.
posted by mudpuppie at 5:07 PM on April 13, 2011

I had a cough for the entire MONTH of January. Finally, my doctor prescribed antibiotics. FINALLY. After a MONTH of being in the doctor's office regularly (which, admittedly, not for the cough itself but rather routine pre-natal visits, but still, the cough and a lot of begging on my part for something to make it go away) - finally some abx.

A lot of times you can get opportunistic secondary infections on top of a pre-existing viral infection, which is one of the reasons why abx are prescribed in cases like this. For me, I can attest that my cough drastically improved with the abx and was gone completely a few days after the course was finished. YMMV, but my recommendation is to just take them. Sure, it's not great to overuse abx, but in this case, it's not going to help you to keep an infection going in your *lungs.* You kinda need your lungs.
posted by sonika at 5:25 PM on April 13, 2011

I had a bad cough for about a month and a half, and my lungs would rattle if I exhaled deeply. I finally went to my doctor, who prescribed two weeks of antibiotics for my bronchitis. After three weeks, my cough had finally cleared up. I could wake up and not hack up a cup of phlegm before work.

If you need antibiotics, don't be ashamed or reluctant to take them just because of naysayers on the Internet, when they are made for your specific healthcare needs. (Just make sure you take the entire course.)
posted by Blazecock Pileon at 5:45 PM on April 13, 2011

Hmmm, I must've been in the 5-10% of bacterial bronchitis cases twice, because both times I've had it I went in to the doctor at about the third week of coughing and both times the prescribed antibiotics cleared it up within a couple of days. Could be a coincidence, but as others have said, once you've started the antibiotics the responsible thing to do is finish them.
posted by TungstenChef at 6:32 PM on April 13, 2011

Nthing take the pills. i get this once at year at least, or I get sinus infections (same deal, can be viral) and it goes on and on and on and I feel like crap unless i just take the damn pills. you're honestly not going to do much damage if you take them and it clears up on its own.
posted by custard heart at 10:48 PM on April 13, 2011

Sorry I didn't get back to the thread sooner, but the other folks who responded are correct that you should generally finish out any antibiotic prescription that you start to prevent resistant bacteria from developing, unless you cannot tolerate the medication for some other reason.
posted by treehorn+bunny at 11:16 PM on April 13, 2011

Yes, once having begun taking antibiotics you need to finish the course of treatment. Eat some yogurt during the treatment to keep your digestive tract populated with good bacteria.

I have a method for fighting off bronchitis (which I get every year during allergy season). I sleep with a heating pad (turned to high heat) positioned over my nose, mouth, and upper chest. I try to breathe as much hot air as I can through my nose. Usually within a couple days the chest congestion breaks up and fluids return to clear. I used to end up at the doctor's office and take antibiotics, but since I've been "baking" my face and chest I haven't had a long bout of bronchitis.
posted by a humble nudibranch at 11:26 PM on April 13, 2011

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