Limits for Antibiotic Treatment Set too Narrow

Abstract

The authors are right to say that purely viral infections do not require antibiotic treatment (1). However, these are rare since secondary bacterial infections frequently occur. During my 45 years as a general practitioner I have noticed that almost all patients with common cold and coughing developed purulent yellow sputum over the course of the infection. Therefore, I believe Holzinger et al. (1) should have mentioned these frequently occurring secondary bacterial infections. The German Pschyrembel Clinical Dictionary (2) mentions as causes of acute bronchitis: „[…] a viral infection with myxoviruses, ECHO viruses, adenoviruses or rhinoviruses; while primary bacterial bronchitis is rather, secondary bacterial infection complicating an existing bronchitis is common (typically caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)“. Likewise, Herold et al. (3) describe purulent sputum as a sign of secondary bacterial superinfection and then bronchopneumonia as a complication of viral bronchitis. In their article Holzinger et al. state, “Administration of antibiotics can be considered in individual patients with serious chronic diseases or immune deficiencies, because in such cases it is often difficult to rule out pneumonia“. I think that this recommendation is too restrictive. Since I know, also from surgery, that pyogenic pathogens are not viruses but bacteria, such as Staphylococcus aureus, among others, which can be treated with antibiotics (4), the following sentence (1) does not appear to be plausible: “Even in the case of bronchitis with yellow–green sputum or mild fever, the patients can be reassured that the infection is most likely viral, so antibiotic treatment is unnecessary.” The yellow–green sputum mentioned should therefore be regarded as a bacterial superinfection secondary to a viral infection, which I have always treated successfully with antibiotics in adult patients with common cold-associated bronchitis, thereby preventing bronchopneumonia as a complication.