Thursday, October 10, 2013
QD: News Every Day--NSAIDs, antibiotics make little difference for cough in acute bronchitis
Neither antibiotics nor NSAIDs reduced the number of days of coughing among patients with uncomplicated acute bronchitis, a study found.
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended mainly for relieving fever, chest pain and cough. And, researchers noted, while most lower respiratory tract infections are viral in nature, antibiotics continue to be overprescribed.
To assess whether either of these two common regimens work in patients with uncomplicated acute bronchitis and discolored sputum, researchers designed a parallel, single-blinded, placebo-controlled, randomized trial at 9 primary care centers in Spain.
Adult patients with a respiratory tract infection of less than one week’s duration, with cough as the predominant symptom, discolored sputum, and at least one other symptom of lower respiratory tract infection such as dyspnea, wheezing, chest discomfort or chest pain, were randomized to receive either ibuprofen 600 mg three times daily, amoxicillin-clavulanic acid 500 mg/125 mg three times daily, or placebo for 10 days.
Results appeared online Oct. 4 at BMJ.
Among the 416 participants randomized (136 to ibuprofen, 137 to antibiotic, and 143 to placebo), 390 returned fully completed symptom diaries. The median number of days with frequent cough was slightly lower among patients assigned to ibuprofen (9 days, 95% CI, 8 to 10 days) vs. those receiving antibiotics (11 days, 95% CI, 10 to 12 days) or placebo (11 days, 95% CI, 8 to 14 days). The differences were not statistically significant. Compared with placebo, the probability of cough resolution did not increase from antibiotics (hazard ratio, 1.03, 95% CI, 0.78 to 1.35) or NSAIDs (HR, 1.23, 95% CI, 0.93 to 1.61).
Adverse events were more common in the antibiotic arm (12%) than ibuprofen or placebo arms (5% and 3%, respectively; P<0.01). 27 patients reported 34 adverse events, including 27 gastrointestinal events, 2 suspected allergic reactions, and 5 other reasons. In the antibiotic group, 16 (12%) reported an adverse event compared to 7 (5%) who received ibuprofen or 4 (3%) who received placebo (P=0.008). 1 patient in the antibiotic group had a digestive hemorrhage that required an ICU admission.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.