Areas Of Uncertainty
Distinguishing the minority of cases of acute bron-
chitis due to a treatable cause from those due to
currently nontreatable viruses i6 often challeng-
in$ Recently, the measurement of serum levels of
procalcitionin, which typically elevated in bacterial infections,
has been proposed as a means of identifying ₩ lents in whom treatment with
antibiotics is warranted. In one clinical trial, low lev-
els of ₩ alcitonin k0.1 pg per liter)
were used to discriminate safely between patients with cough or dyspnea
who did not require antibiotic therapy,such ther those with acute bronchitis, 38 and patients
who did require such therapy. However, more data
are needed to validate the usefulness of the pro-
calcitonin test for discriminating between patients
with bronchitis and tbose with pneumoni
AJthough clinicians might argue that the pres-
sure of dme inmces the prescribing of antibi-
otics, the data do not support this contention,
A recmt study involving almost 4000 adults witt
upper respiratory tract infections showed that th €
mean duration of an office visit was 14.2 minutes
when antibiotics were prescribed, as compared
with 15.2 mimrtes when no pres« xiption for anti·
biotics was given. 39
Www.is sa]dies involving volunteers exposed t(
ovi rus snowed that nonsteroidal drugs alom