Letters Caring with evidence based medicine

Evidence based medicine and bronchiolitis: don’t ignore uncertainties

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3938 (Published 19 July 2016) Cite this as: BMJ 2016;354:i3938
  1. Caroline Mawer, general practitioner
  1. London, UK
  1. caroline.mawer{at}gmail.com

Isn’t the practice update on bronchiolitis in The BMJ on 2 July (p 29) an example of evidence based medicine that injects certainty, rather than doing justice to all of the uncertainties that exist for clinicians and parents?1 I agree strongly that children with viral infections don’t benefit from, and may even be harmed by, antibiotics—and that very many children with bronchiolitis do not need hospital admission.

Just reminding doctors of the guidelines doesn’t really help a doctor faced with a child struggling to breathe. Many anxious parents will not be reassured if they’re simply told that the condition is self limiting and that their child’s breathing and feeding will get better within five days.2

Improved evidence on admission avoidance does indeed need “to be done”(sic), but, if we were going to follow the more practical approaches suggested elsewhere in the 2 July issue,3 it may be more useful to work on some more specific and practical ways forward.

Why aren’t there more evidence based, parent-friendly resources such as whenshouldiworry.com? Trials of that site showed a two thirds reduction in antibiotic prescribing,4 and, in my experience as well as in trials, many parents really like it.

Are there any near patient diagnostic tests that might help—such as C reactive protein, as used in a recent NHS Innovation award winning project to reduce antibiotic prescribing in adults with a cough?5

It’s good news that reminding higher antibiotic prescribers of their outlier status has led to reductions in antibiotic use.6 But surely, with antimicrobial resistance flagged up as a potentially devastating global threat,7 we need to do more than wag fingers at doctors. And developing more practical supports surely applies more widely than just to bronchiolitis.


  • Competing interests: None declared.


View Abstract