From the Guidelines
For patients on dialysis with acute bronchitis in the outpatient setting, azithromycin (500 mg on day 1, then 250 mg daily for 4 days) is a suitable antibiotic option, as it is primarily metabolized by the liver and does not require dosage adjustment for dialysis patients. When considering antibiotic treatment, it's essential to note that most cases of acute bronchitis are viral in nature, and antibiotics are generally not recommended unless there are specific indications such as suspected bacterial infection, underlying chronic lung disease, or immunocompromise 1.
Key Considerations
- Macrolides like azithromycin are effective against common respiratory pathogens while being safe for patients with renal impairment.
- Doxycycline (100 mg twice daily for 5-7 days) is another option, as it is eliminated through non-renal pathways.
- Trimethoprim-sulfamethoxazole (TMP-SMX, one double-strength tablet twice daily for 5-7 days) can be used, but patients should be monitored closely for adverse effects, particularly the risk of hyperkalemia in dialysis patients.
- According to the guidelines for preventing opportunistic infections among HIV-infected persons, dosage adjustments for certain antibiotics are necessary in patients with renal dysfunction, but azithromycin is not listed, suggesting its safety in this population 1.
Dosage Adjustments
- For patients on hemodialysis, the choice of antibiotics and dose adjustments should be made based on comments from the patient’s nephrologist before the treatment to decrease the side effects from chronic kidney disease (CKD) 1.
- Aminoglycoside antibiotics and tetracyclines should be avoided in CKD patients due to their nephrotoxicity.
- Nitrofurantoin can also produce a toxic metabolite, which can cause peripheral neuritis, and should be avoided in patients with CKD.
Monitoring and Safety
- Patients on dialysis should be closely monitored for adverse effects when taking antibiotics, particularly with TMP-SMX, which may increase the risk of hyperkalemia.
- The American Heart Association (AHA) recommendations suggest that patients should take amoxicillin orally or ampicillin intramuscularly (IM) or intravenously (IV) for prophylactic antibiotics before invasive dental procedures, but this may not be directly applicable to acute bronchitis treatment 1.
From the Research
Antibiotic Treatment for Acute Bronchitis in Outpatient Setting
- The use of antibiotics for acute bronchitis is generally not recommended, as it is usually caused by viruses 2, 3.
- Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection 2, 3.
- However, in cases where bacterial infection is suspected, antibiotics such as clarithromycin and azithromycin may be considered 4, 5.
- A 5-day course of clarithromycin extended-release 1000 mg once daily has been shown to be effective in treating acute bacterial exacerbation of chronic bronchitis 4.
- A 3-day course of azithromycin 500 mg once daily has been shown to be equivalent to a 10-day course of clarithromycin 500 mg twice daily in treating acute exacerbation of chronic bronchitis 5.
Considerations for Patients on Dialysis
- There is no specific evidence provided on the use of antibiotics for acute bronchitis in patients on dialysis.
- However, it is generally recommended to use caution when prescribing antibiotics to patients with renal impairment, as they may require dose adjustments or alternative treatments 4, 5.