What is the diagnosis and treatment for acute bronchitis?

From the Guidelines

Bronchitis is typically caused by viral infections and resolves within 1-2 weeks without antibiotics, and treatment should focus on symptom relief. The most recent and highest quality study, 1, suggests that for immunocompetent adult outpatients with cough due to suspected acute bronchitis, no routine investigation with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin is recommended.

Diagnosis and Treatment

• The diagnosis of acute bronchitis should be made based on clinical evaluation, ruling out serious illness, particularly pneumonia, as recommended by 1.
• Antibiotics are generally not recommended unless there's evidence of bacterial infection, as stated in 1 and 1.
• Treatment should focus on symptom relief, including rest, staying hydrated, using over-the-counter pain relievers like acetaminophen or ibuprofen for fever and discomfort, and using honey for cough, as suggested by the example answer.
• A humidifier can help loosen mucus, and avoiding irritants like smoke is important, as mentioned in the example answer.

Management Approaches

• For immunocompetent adult outpatients with cough due to acute bronchitis, if the acute bronchitis worsens, consideration for treatment with antibiotic therapy should be made if a complicating bacterial infection is thought likely, as recommended by 1.
• Chronic bronchitis, lasting at least three months in two consecutive years, may require different management approaches, including bronchodilators and possibly corticosteroids, as mentioned in the example answer.
• The distinction between viral and bacterial causes is important because unnecessary antibiotic use contributes to antibiotic resistance without providing benefit for viral infections, as stated in 1 and 1.

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

The clinical cure rate for azithromycin in the treatment of acute bacterial exacerbations of chronic bronchitis is 85%.

• The primary endpoint of the trial was the clinical cure rate at Day 21 to 24.
• Key findings include a clinical cure rate of 85% for 3 days of azithromycin compared to 82% for 10 days of clarithromycin 2.

From the Research

Definition and Diagnosis of Bronchitis

• Bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia 3, 4, 5.
• The differential diagnosis includes exacerbations of preexisting conditions, such as asthma, chronic obstructive pulmonary disease, and heart failure or other causes of acute cough, including pertussis, COVID-19, influenza, and community-acquired pneumonia 5.
• Diagnostic testing is not indicated unless there is concern for other potential causes, such as community-acquired pneumonia, influenza, or COVID-19 5.

Symptoms and Duration of Bronchitis

• Cough is the most common symptom of bronchitis, and it typically lasts about two to three weeks 3, 4, 5.
• The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 4.
• Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease 3, 4, 6.

Treatment and Management of Bronchitis

• 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 3, 6.
• Evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids 5.
• Symptom relief and patient education regarding the expected duration of cough are recommended for the management of acute bronchitis 3, 5.
• Strategies shown to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold 3, 5, 6.