From the Research
For bronchitis, a typical antibiotic regimen includes ceftriaxone 1-2 grams given once daily intravenously or intramuscularly, combined with azithromycin 500 mg orally on day one, followed by 250 mg orally daily for 4 additional days (total 5-day course). This combination is particularly useful for moderate to severe cases or when there's concern for atypical pathogens 1. However, it's essential to note that most cases of acute bronchitis are viral and don't require antibiotics at all. Antibiotics should be reserved for cases with suspected bacterial infection, such as those with purulent sputum, fever, or in patients with underlying lung disease.
Key Considerations
- Ceftriaxone targets common respiratory bacteria like Streptococcus pneumoniae and Haemophilus influenzae, while azithromycin covers atypical pathogens like Mycoplasma and Chlamydia 2.
- Potential side effects include diarrhea, nausea, and allergic reactions.
- Patients should complete the full course even if symptoms improve and stay hydrated to help thin secretions and facilitate expectoration.
- The choice of antibiotic regimen should be based on the severity of the disease, the presence of underlying conditions, and the likelihood of bacterial infection 3.
Evidence Summary
- A study comparing azithromycin and co-amoxiclav in the treatment of acute tracheobronchitis and acute infectious exacerbations of chronic bronchitis found that azithromycin produced a significantly higher cure rate and fewer failures and relapses 1.
- Another study evaluating the efficacy of ceftriaxone in the treatment of bronchopulmonary infections found that the drug was effective in 95% of patients 2.
- A post hoc analysis of data from a previous randomized, blinded, multicenter, parallel, noninferiority study assessed the bacterial etiology, symptom resolution, and tolerability of severe acute bacterial exacerbation of chronic bronchitis patients treated with either levofloxacin or amoxicillin/clavulanate, and found that levofloxacin was effective in resolving symptoms and had a higher susceptibility rate against pathogens 3.