Incidence Rate of Acute Bronchitis

Final Paper
Student Name
Institutional Affiliation
Course Full Title
Instructor Full Name
Due Date
Final Paper
Problem Statement
The yearly incidence rate of acute bronchitis is about 5%, where most infections occur during the flu season, usually around the winter and autumn periods in America. Nearly every patient with self-diagnosed acute bronchitis symptoms seeks medical attention: over 10 million patients consult health care providers when demonstrating lower respiratory tract infection symptoms, especially bronchitis (Singh et al., 2021; Fu et al., 2021). Some of the risk factors related to acute bronchitis include a history of smoking, allergens, overcrowding, asthma, and pollutants (Singh et al., 2021). Some studies show that viruses are the etiological agents in up to a quarter of community cases, while other studies indicate a slightly higher percentage for atypical bacteria.
Some of the health concerns resulting from respiratory illness include blood-tinged sputum, difficulty breathing, higher cardiac rates, greater tachypnea, increased body temperatures, as well as a higher risk of tactile fremitus and lung consolidation (Kinkade & Long, 2016). There is a growing concern among clinicians about antibiotic abuse during the treatment and management of acute bronchitis symptoms. Studies indicate that physicians are 70% likely to give antibiotics to patients, thereby predisposing 44% of the population to develop antibiotic resistance. Studies show no significant clinical advantages from prescribing antibiotics since most symptoms are secondary to viral infections (Fu et al., 2021). The most commonly prescribed drugs are second-generation and third-generation macrolides, cephalosporins, and broad-spectrum penicillin.
Various researchers have highlighted the need to identify alternative treatment interventions due to the adverse side effects of antibiotics and the more detrimental impact of antibiotic resistance, limiting acute bronchitis patients' ability to profit from antibiotics in the future. Existing studies investigating the efficacy of antibiotics concerning the supportive treatment in treating acute bronchitis indicate no significant differences between the two interventions. Despite the growing number of studies investigating the feasibility of other interventions that can replace antibiotics as the choice of treatment for acute bronchitis, very few studies have managed to accurately demonstrate the relative efficacy of alternative treatment options concerning antibiotics. This study will fill this knowledge gap by comparing supportive treatment and antibiotics' health and life outcomes. The findings will help bolster existing results supporting alternative interventions to replace antibiotics.
Organizational Culture and Readiness
Although national guidelines founded on randomized controlled trials and meta-analyses continue to advocate against antibiotic prescribing when treating acute bronchitis, physicians in America continue to issue antibiotics in a majority of patient visits (Petrovic et al., 2019). While most clinicians understand that antibiotic prescriptions heighten the prevalence of antibiotic-resistance bacteria, raise healthcare expenses, and provide no clinical improvement, specific barriers continue to foster the unproductive culture. Some of the perceived barriers to change include perceived patient demand for antibiotics, inefficient accountability of antibiotic prescribing, clinician misconceptions regarding acute bronchitis, diagnostic uncertainty, and clinicians' desire to meet patient expectations (Havers et al., 2018).
Readiness to change is impeded by a general perception among clinicians that most patients with acute bronchitis expect their doctors to give them antibiotics. Physicians have little regulation or accountability when prescribing antibiotics, especially given the existing culture of over-the-counter antibiotics. Moreover, there is still the misconception among health care providers that bacterial infections cause acute bronchitis. A significant proportion of clinicians continue to rigidly hold on to the belief that antibiotics are harmless and therefore see no need to start changing their treatment regimen (Petrovic et al., 2019). Besides, when faced with diagnostic uncertainty, several healthcare providers resort to defensive practice by prescribing antibiotics to be on the safe side. At the same time, some clinicians feel that giving antibiotics is the only way to ensure they have met patient expectations.
Literature Review
Introduction
Acute bronchitis is a common illness during the flu season, with up to 90% of patients requiring clinical consultation. It is also one of the most prevalent illnesses, with ten million hospitalization cases in patients diagnosed with lower respiratory tract infections (Singh et al., 2021). Most health care providers issue antibiotics as the first line of defense when addressing coughing symptoms among patients. However, antibiotics have been shown to result in adverse effects, including vomiting, Clostridium difficile infection, allergic reactions, and nausea (Mohsen et al., 2020). This is a serious cause of concern in the nursing practice. Several clinicians have urged the importance of evidence-based care that alleviates the negative side effects of antibiotics in treating acute bronchitis.
This study will address this concern by comparing antibiotics in treating acute bronchitis with supportive treatment. The aim is to find an alternative form of treatment that will treat the disease and associated symptoms with fewer negative side effects. The PICOT question of this study is: In patients with acute bronchitis (Population), how effective are antibiotics (Intervention) in comparison to supportive treatment (Comparison) in decreasing the disease burden and length of illness (Outcome) in 7 days of treatment (Time)?
Search methods
The study will conduct a systemic review on various research databases, including PubMed, Science Direct, ProQuest, and Google Scholar. To help search efforts at locating relevant sources, the following keywords will be used: acute bronchitis, coughing symptoms of acute bronchitis, supportive treatment, side effects, respiratory tract infection, traditional treatment, antibiotics, and decreasing length of illness. The study will focus on those peer-reviewed articles that directly relate to the PICOT question and have been published within the last five years.
Synthesis of the Literature
The analysis of peer-reviewed articles relating to the PICOT questions revealed a pattern of outpatient clinics tending to unnecessarily prescribe antibiotics. There is a considerable over-prescription of antibiotics in America, with up to 44% of outpatient clinics giving the same for acute bronchitis. One of the most common symptoms of acute bronchitis is coughing due to the airways’ inflammation, even though this symptom is shared by other common respiratory illnesses such as pneumonia. Several studies showed that the general rate of prescribing antibiotics for general acute respiratory infections was between seven and nine times higher than what is advised by health guidelines. Antibiotics are better suited for other respiratory-related illnesses such as acute rhinosinusitis, community-acquired pneumonia, pertussis, acute pharyngitis, and otitis media. The findings of the various articles indicate that despite the tendency to issue antibiotics to patients diagnosed with acute bronchitis, there is little clinical improvement.
Worse, there is a growing incidence of people developing antibiotics resistance even when the symptoms of acute bronchitis tend to disappear within two or three weeks after infection. The literature review showed that antibiotics are the common treatment among adult patients (46.4%), although 65.2% of patients use symptom management medications like expectorants, Chinese traditional medicine, and antihistamines. Most studies also indicated that supportive treatment is the best and most effective treatment regimen for acute bronchitis symptoms for most patients. Overall, the systemic review demonstrated that the current level of antibiotic prescription is much greater than what is stipulated in clinical guidelines and that targeted and more effective interventions are required to improve the clinical care of patients with acute bronchitis (Fu et al., 2021).
Numerous studies showed that the current over-prescription of antibiotics affected patients’ succeeding incidences of acute bronchitis. After conducting a retrospective study of pediatric patients with acute bronchitis, those prescribed antibiotics were discovered to develop a pattern of increased susceptibility to subsequent episodes compared to those who did not receive antibiotics during their first treatment of the illness. Consequently, the studies demonstrated that antibiotic prescriptions for acute bronchitis heightened the risk of recurring episodes instead of other treatment options (Morgan et al., 2019). Most studies in the literature review recommended that clinical guidelines limit antibiotic prescription and more stringent health guidelines be implemented to ensure proper treatment and management of acute bronchitis (McCullough et al., 2017).
Because of the rampant over-prescription of antibiotics, even for minor cases of acute bronchitis, there has been increased attention to the issue among clinicians. It is now considered a global priority in healthcare. Studies indicate that broad-spectrum antibiotics are the most over-used because they constitute up to 97.8% of all antibiotic prescriptions. Macrolides, and especially azithromycin, are the most prescribed drugs. It was also discovered that clinicians tend to prescribe antibiotics mostly to middle-aged patients (those between 18 and 39). At the same time, this tendency to issue antibiotics among this group was tied to associated drug resistance along with numerous other side effects like nausea, vomiting, and bloating, among other adverse symptoms (Grigoryan et al., 2017).
The study by Haskell et al. (2021) involved a randomized clinical trial study in a pediatric setting. The research objective was to investigate the effectiveness of targeted interventions when treating bronchiolitis symptoms like wheezing and coughing. Some of the primary interventions used by the authors included targeted educational delivery, feedback, site-based clinical leads, audit, and stakeholder meetings. The study showed that the targeted interventions resulted in improved symptoms in up to 26 hospitals with patients suffering from respiratory issues. Haskell et al. (2021) discovered that targeted interventions were a useful alternative in addressing ongoing concerns about the harmful treatment and management of acute bronchitis using antibiotics, glucocorticoids, and albuterol. Clinicians have increasingly hailed symptoms management as a successful substitute treatment option for acute bronchitis. Furthermore, herbal medicine is an effective treatment option that health care providers can implement to provide symptom relief for coughing.
One study used a randomized clinical trial where phone interviews with a health care professional and patients revealed that herbal medications were preferred because they were deemed "less intrusive" than antibiotics. Another reason clinicians and patients prefer other ways of treating and managing acute bronchitis is the issue of drug resistance, implying that patients are already aware of the debilitating effects of relying on antibiotics. Another added advantage of complementary medicine is its accessibility. However, several health care providers have cautioned that herbal medicines may result in negative drug interactions when taken together with conventional medication. Consequently, despite the advantages of herbal medicines, evidence-based guidelines are necessary when prescribing herbal medicines to patients with acute bronchitis (Soilemezi et al., 2020).
Several studies in the literature review investigated the viability of anticholinergics, honey, and antitussives as alternative treatment options for patients with moderate acute bronchitis (those with cough symptoms that had persisted for less than three weeks). Cots et al. (2019) conducted a randomized clinical trial where participants were split into four groups: the first group was the clinical practice group; the second received dextromethorphan (15mg) three times in a day; the third group was given ipratropium bromide (20 µg per puff) two puffs three times every day, and the last group got a dose of one tablespoon of honey three times a day. All groups received these treatments for two weeks where acute bronchitis symptoms, especially cough symptoms, were reported in a journal and scored on a 7-Likert scale. The study determined that the other treatment options besides standard clinical treatment effectively treated and managed acute coughing, thereby providing a solution to the current preference for antibiotics. Unfortunately, there is still no accurate way to compare the relative efficacy of these treatment interventions when treating lower respiratory tract infections (Cots et al., 2019).
Alternative forms of cough treatment such as honey have a placebo effect on patients demonstrating coughing symptoms. Several clinicians attribute the placebo effect of love to the physiological effect of its sweetness and the body’s capacity to recover naturally. This effect can be advantageous when treating acute bronchitis by capitalizing on the positive effects to facilitate similar clinical outcomes, thereby reducing overreliance on antibiotics as the primary form of medication (Eccles, 2020). Besides the adverse side effects of antibiotics, the bigger concern is drug resistance. The fact that antibiotics are only effective for a short period before the patient begins developing resistance to their efficacy, over and above, increasing the possibility of successive incidences of respiratory infections, heightens the need for alternative treatment options.
Given that current studies have not yet established the relative efficacies of various alternative treatments, clinical research must improve their sample sizes to increase the objectivity of outcome measures. Health care providers must only give antibiotics after exhausting other alternative treatment methods to reduce over-dependence on antibiotics.
Suggestions for Future Research
Other treatment interventions besides antibiotics must be found to improve treatment of acute bronchitis about adverse side effects and drug resistance. There is a need for more objective data collection procedures and outcome measures when evaluating the efficacy of various alternative treatments, including sputum samples and x-rays. Quantitative studies must incorporate larger sample sizes when considering possible treatments for acute bronchitis to arrive at reliable results that can help reduce unnecessary prescriptions of antibiotics. Moreover, clinicians should be more conversant and aware of the latest evidence on the use of various treatment options when managing acute bronchitis as they seek to overturn the current trend of over-prescribing antibiotics.
Change Model
The study will implement Kurt Lewin's change management model, which consists of three phases: unfreezing, changing, and refreezing. Lewin developed an implementation model of transforming new behaviors into new norms in an organizational setting using a simple and practical process of reinforcing the change process. As a social scientist, Lewin dedicated himself to understanding the practices underpinning the literature's theoretical and practical philosophies of organizational change. His change model starts with creating the perception that change is necessary, then moves toward implementing the desired behaviors before solidifying the same to become a norm.
It provides the person leading the change effort with a framework to guide the process and considers the various concerns involved in dealing with change resistance and reinforcing intended behaviors (Wojciechowski et al., 2016). The study challenges existing practice guidelines relating to the treatment of acute bronchitis. Although the American Family Physician medical journal strongly discourages antibiotic prescription when treating upper respiratory tract infections, most clinicians continue to give antibiotics to patients. Consequently, this study will require Lew...