From the Guidelines
Acute bronchitis treatment should focus on symptom relief, and antibiotics should not be routinely used, as most cases are viral. The most recent and highest quality study, 1, recommends against routine antibiotic treatment in the absence of pneumonia. This study found limited evidence to support the use of antibiotics for acute bronchitis and a trend toward increased adverse events in patients treated with antibiotics.
Symptom Relief
To manage symptoms, patients can use over-the-counter medications like:
- Acetaminophen (Tylenol, 325-650mg every 4-6 hours, not exceeding 3000mg daily) or ibuprofen (Advil, 200-400mg every 4-6 hours with food) to manage fever and discomfort
- Dextromethorphan (Robitussin DM, 10-20mg every 4 hours) or honey (1 tablespoon as needed, not for children under one year) for cough relief
- A humidifier or steam inhalation can loosen mucus and ease breathing
Antibiotic Use
Antibiotics are generally not recommended, but may be prescribed if bacterial infection is suspected or in high-risk patients, as stated in 1. The study 1 also mentions that determining whether a patient has a viral or nonviral cause can be difficult, and the presence of purulent sputum or a change in its color does not signify bacterial infection.
Bronchodilators
Bronchodilators like albuterol may help if wheezing is present, as mentioned in 1. This study found that approximately 50% fewer patients report the presence of cough after 7 days of treatment with albuterol.
Prevention and Complications
Patients should avoid smoking and irritants that can worsen symptoms. Seek medical attention if symptoms worsen, breathing becomes difficult, fever exceeds 100.4°F for more than three days, or if you have underlying conditions like COPD or heart disease that might complicate recovery, as recommended in 1.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants To treat acute bronchitis, guaifenesin (PO) can be used to help loosen phlegm and thin bronchial secretions, making coughs more productive 2. Additionally, dextromethorphan (PO) can be used to temporarily relieve cough due to minor throat and bronchial irritation 3.
- Key considerations:
- Use guaifenesin to make coughs more productive
- Use dextromethorphan to relieve cough due to minor throat and bronchial irritation
From the Research
Treatment Options for Acute Bronchitis
- Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting 4
- Therapy consists of both nonpharmacological and pharmacological options to include antibiotics and antivirals, antitussive agents, protussive agents, and beta-2-agonists 4
- The supplement pelargonium may help reduce symptom severity in adults 5
Use of Antibiotics
- 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 5
- 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 6
- Antibiotics do not contribute to the overall improvement of acute bronchitis; although they may decrease the duration of cough by approximately 0.5 days, their use exposes patients to antibiotic-related adverse effects 7
Management of Acute Bronchitis
- 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 6
- Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold 6, 7
- Symptom relief and patient education regarding the expected duration of cough (2-3 weeks) are recommended for the management of acute bronchitis 7
Effectiveness of Treatments
- Evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids 7
- A systematic review found that antibiotics, antihistamines, antitussives, beta2 agonists (inhaled), and expectorants/mucolytics have varying levels of efficacy and safety in the treatment of acute bronchitis 8