From the Guidelines
Bronchitis in adults should not be treated with routine antibiotic therapy, but rather with symptom relief using over-the-counter medications such as acetaminophen, ibuprofen, dextromethorphan, and guaifenesin, as well as rest and increased fluid intake. The treatment of bronchitis in adults focuses on managing symptoms, as most cases are viral in nature [(1, 2)].
Symptomatic Relief
Symptomatic relief can be achieved with medications like:
- Acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours for pain and fever
- Over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM) for persistent cough
- Expectorants with guaifenesin to help thin mucus A humidifier or steam inhalation can also help loosen mucus 1.
Antibiotic Therapy
Antibiotics are generally not recommended for acute bronchitis unless there's evidence of bacterial infection [(1, 2)]. The most recent clinical guidelines recommend against routine antibiotic treatment in the absence of pneumonia 1.
Chronic Bronchitis
For chronic bronchitis, inhaled bronchodilators like albuterol may be prescribed to open airways, along with inhaled corticosteroids to reduce inflammation 1. Smoking cessation is crucial for recovery, as continued smoking worsens bronchitis and delays healing.
When to Seek Medical Attention
If symptoms worsen, including high fever, difficulty breathing, or coughing up blood, medical attention should be sought immediately as these may indicate pneumonia or other serious complications [(1, 2)].
From the FDA Drug Label
Adult PatientsAcute Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease In a randomized, double-blind controlled clinical trial of acute exacerbation of chronic bronchitis (AECB), azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days). The primary endpoint of this trial was the clinical cure rate at Day 21 to 24 For the 304 patients analyzed in the modified intent to treat analysis at the Day 21 to 24 visit, the clinical cure rate for 3 days of azithromycin was 85% (125/147) compared to 82% (129/157) for 10 days of clarithromycin
Treatment of Bronchitis in Adults:
- Azithromycin (500 mg once daily for 3 days) can be used to treat acute bacterial exacerbations of chronic bronchitis (AECB) in adults.
- The clinical cure rate for azithromycin was 85% at Day 21 to 24.
- Common side effects include diarrhea, nausea, and abdominal pain. 3
From the Research
Treatment Options for Bronchitis in Adults
- The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective 4
- Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older) 4, 5
- The supplement pelargonium may help reduce symptom severity in adults 4
- Therapy consists of both nonpharmacological and pharmacological options to include antitussive agents, protussive agents, and beta-2-agonists 6
- Albuterol had an impressive advantage over erythromycin in some studies 7
When to Use Antibiotics
- Antibiotics should not be used in the treatment of acute bronchitis in healthy persons unless convincing evidence of a bacterial infection is present 7
- 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 5
Symptomatic Treatment
- Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting 6
- Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use 5