What are the treatment options for acute bronchitis (inflammation of the bronchial tubes)?

From the Guidelines

Bronchitis treatment should focus on symptom relief, with antibiotics generally not recommended unless there's clear evidence of bacterial infection, as suggested by the most recent and highest quality study 1. The treatment approach for bronchitis, particularly acute bronchitis, typically involves addressing the underlying viral cause and managing symptoms. Key considerations include:

• Rest and increased fluid intake to help the body recover
• Over-the-counter medications like acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) for fever and pain management
• Use of a humidifier to loosen mucus and ease coughing
• Cough suppressants containing dextromethorvan may be used for severe coughing, especially at night, although their effectiveness can depend on the cause of the cough For chronic bronchitis, treatments may include:
• Bronchodilators such as albuterol (2 puffs every 4-6 hours as needed) to help open airways
• Inhaled corticosteroids like fluticasone (1-2 puffs twice daily) to reduce inflammation
• Oral corticosteroids like prednisone (typically 40mg daily for 5 days, tapering down) for severe cases Smoking cessation is crucial for recovery, as continued smoking can worsen bronchitis and delay healing 1. Pulmonary rehabilitation may also benefit those with chronic bronchitis by improving breathing techniques and exercise tolerance. It's essential to note that the initial clinical evaluation is critical in the longitudinal care of patients, and differential diagnoses such as exacerbations of chronic airways diseases should be considered 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 treatment of bronchitis with azithromycin has a clinical cure rate of 85% when administered at 500 mg once daily for 3 days, as compared to 82% for 10 days of clarithromycin 2.

• Key points:
  • Azithromycin dosage: 500 mg once daily for 3 days
  • Clinical cure rate: 85%
  • Comparison: clarithromycin (500 mg twice daily for 10 days) with a clinical cure rate of 82%
• Common side effects include diarrhea, nausea, and abdominal pain, with comparable incidence rates for each symptom of 5 to 9% between the two treatment arms.

From the Research

Treatment Options for Bronchitis

• The treatment of bronchitis typically involves symptomatic relief, as the condition is often self-limiting 3, 4, 5.
• Therapy may include nonpharmacological and pharmacological options, such as antitussive agents, protussive agents, and beta-2-agonists 3.
• Antibiotics are generally not indicated for bronchitis, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia 4, 5.

Antibiotic Use in Bronchitis

• Studies have shown that antibiotics provide only minimal benefit in reducing the duration of cough or illness in bronchitis patients, and may have adverse effects 4, 5.
• Azithromycin and amoxicillin/clavulanic acid have been compared in the treatment of acute purulent exacerbation of chronic bronchitis, with amoxicillin/clavulanic acid showing higher efficacy rates 6.
• Another study compared azithromycin and co-amoxiclav in the treatment of acute tracheobronchitis and acute infectious exacerbations of chronic bronchitis, with azithromycin producing a higher cure rate and fewer failures and relapses 7.

Symptomatic Treatment

• Symptomatic treatment of cough is primarily required for patients with bronchitis, and may include the use of antitussive agents and protussive agents 3.
• The supplement pelargonium may help reduce symptom severity in adults with bronchitis 4.
• Patient education and effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 4, 5.