Four reviews and still no answers: our clinical definitions are at fault

Acute bronchitis is one of the commonest medical problems managed by health services, and one of the important clinical questions is whether antibiotics do any good. Fittingly, for such a common problem, there have been four systematic reviews comparing antibiotics with placebo for treating bronchitis. All, however, have reached clinically unhelpful conclusions, which simply exposes the perennial problem for all systematic reviews that demonstrate no or only marginal benefits from the intervention: is there a subgroup that might derive benefit? It also exposes the procrustean nature of our definitions of acute bronchitis.*

Three of the reviews included meta-analyses11-33 and one was a qualitative systematic review of the literature.4 They include almost all the same studies,† although Fahey et al2 called their review a systematic review of acute cough in adults and included unpublished data from Stephenson. They all came to similar ambiguous and clinically unhelpful conclusions, the most negative being, “the current literature does not support antibiotic treatment for acute bronchitis,”4 while the most positive concluded, “antibiotics may be modestly effective …