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Bronchitis (Acute)

Novel and Emerging Strategies

Simple Blood Test Helps Avoid Antibiotic Overuse in Acute Bronchitis

Despite being aware that the vast majority of acute bronchitis cases are caused by viruses, many physicians haphazardly prescribe antibiotics for this condition. Aside from being ineffective against a viral infection, antibiotic overuse drives the emergence of potentially devastating antibiotic resistant organisms (Huang 2004; Erb 2007; Livermore 2000; Jones 2001).

Emerging evidence shows that a simple blood test can help differentiate between bacterial and viral infections, allowing physicians to refrain from prescribing antibiotics for conditions caused by viruses. This blood test assesses levels of procalcitonin (PCT), a hormone secreted by the body in response to a bacterial infection (LabCorp 2013; Chist-Crain 2004; Achanta 2012).

Several randomized, controlled trials have shown that antibiotic prescriptions in acute bronchitis have been reduced by up to 80% when procalcitonin measurements were utilized as part of the diagnostic algorithm (Schuetz 2010). A 2013 comprehensive review concluded “Procalcitonin guidance can safely reduce antibiotic usage… when used to initiate or discontinue antibiotics in adults with respiratory tract infections.” (Soni 2013; Schuetz 2010). 

Cimetidine

The antiviral drug cimetidine (Tagamet®), which is used to help relieve heartburn, is a pharmaceutical option to provide immune system support in the context of viral infection (Palmer 1990). Cimetidine has potent immune system-boosting effects, which are thought to explain its ability to drastically reduce the severity and duration of certain viral infections (van der Spuy 1980; White 1985; Cohen 1988; Hast 1989; Wang 2008). Cimetidine, in 200 mg tablets, is available for OTC purchase (Allen 2000). It is safe for most adults and does not have serious adverse effects; while the OTC package insert indicates up to 800 mg can be taken daily, some studies have used up to 1000 mg daily without any obvious adverse effects (Harvey 1984; Rohner 1984; Choi 1993; Allen 2000).