E-drug: Azithromycin no value for acute bronchitis
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[This study is an interesting confirmation that antibiotics are rarely
indicated for acute bronchitis, but unfortunately often promoted and
prescribed. Copied as fair use. KM, moderator]
Lancet 2002; 359: 1648-54 (11 May 2002)
Azithromycin for acute bronchitis: a randomised, double-blind, controlled
trial
Arthur T Evans, Shahid Husain, Lakshmi Durairaj, Laura S Sadowski, Marjorie
Charles-Damte, Yue Wang
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Collaborative Research Unit, Department of Medicine, Cook County Hospital
and Rush Medical College, Chicago, IL (A T Evans MD, L S Sadowski MD, M
Charles-Damte RN, Y Wang PhD); Division of Infectious Diseases, University
of Pittsburgh Medical Center, Pittsburgh, PA (S Husain MD); and Division of
Pulmonary, Critical Care and Occupational Medicine, University of Iowa
College of Medicine, Iowa City, IA, USA (L Durairaj MD)
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Correspondence to: Dr Arthur T Evans, Collaborative Research Unit, Cook
County Hospital, Room 1600, Administration Building, 1900 W Polk St,
Chicago, IL 60612, USA (e-mail:aevans@cchil.org)
Summary
Background The value of azithromycin for treatment of acute bronchitis is
unknown, even though this drug is commonly prescribed. We have investigated
this question in a randomised, double-blind, controlled trial.
Methods Adults diagnosed with acute bronchitis, without evidence of
underlying lung disease, were randomly assigned azithromycin (n=112) or
vitamin C (n=108) for 5 days (total dose for each 1�5 g). All individuals
were also given liquid dextromethorphan and albuterol inhaler with a spacer.
The primary outcome was improvement in health-related quality of life at 7
days; an important difference was defined as 0�5 or greater. Analysis was by
intention to treat.
Findings The study was stopped by the data-monitoring and safety committee
when 220 patients had been recruited. On day 7, the adjusted difference in
health-related quality of life was small and not significant (difference
0�03 [95% CI -0�20 to 0�26], p=0�8). 86 (89%) of 97 patients in the
azithromycin group and 82 (89%) of 92 in the vitamin C group had returned to
their usual activities by day 7 (difference 0�5% [-10% to 9%], p>0�9). There
were no differences in the frequency of adverse effects; three patients in
the vitamin C group discontinued the study medicine because of perceived
adverse effects, compared with none in the azithromycin group. Most patients
(81%) reported benefit from the albuterol inhaler.
Interpretation Azithromycin is no better than low-dose vitamin C for acute
bronchitis. Further studies are needed to identify the best treatment for
this disorder.
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