What is the treatment for acute bronchitis?

From the Guidelines

Acute bronchitis treatment primarily focuses on symptom relief while the infection resolves naturally, with antibiotics typically not recommended as most cases are viral, not bacterial, as suggested by the most recent study 1. The treatment approach involves managing symptoms to improve the patient's quality of life. Key components include:

• Rest and increased fluid intake to help the body recover
• Over-the-counter medications like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 4-6 hours to manage fever and discomfort
• Cough relief medications such as dextromethorphan (Robitussin DM) 10-20mg every 4 hours or guaifenesin (Mucinex) 600-1200mg every 12 hours
• Use of a humidifier or steam inhalation to loosen mucus and ease breathing It's essential to note that antibiotics should only be considered if a complicating bacterial infection is thought likely, as stated in 1. Smoking cessation is also crucial as it worsens symptoms and delays recovery. Most cases of acute bronchitis resolve within 1-3 weeks, but the cough may linger for several weeks afterward. If symptoms persist beyond 2-3 weeks, worsen significantly, or include high fever, severe shortness of breath, or bloody mucus, medical attention should be sought immediately, as advised 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 treatment for acute bronchitis is azithromycin (500 mg once daily for 3 days), which has a clinical cure rate of 85% compared to 82% for 10 days of clarithromycin 2.

• The clinical cure rates at the Day 21 to 24 visit for the bacteriologically evaluable patients by pathogen are:

• S. pneumoniae: 91%
• H. influenzae: 86%
• M catarrhalis: 92% The most common side effects are 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 Acute Bronchitis

• Mucoactive medications, including expectorants, mucolytics, and mucokinetic drugs, may be used to treat acute bronchitis 3
• Expectorants, such as guaifenesin, are meant to increase the volume of airway water or secretion to increase the effectiveness of cough, but there is no evidence that they are effective for the therapy of any form of lung disease 3
• Mucolytics, such as N-acetylcysteine, have no proven benefit and carry a risk of epithelial damage when administered via aerosol 3
• Combination drugs containing ambroxol, guaifenesin, and levosalbutamol may be effective in treating productive cough in adult patients with acute bronchitis, with superior efficacy compared to fixed-dose combinations of bromhexine/guaifenesin/salbutamol 4

Efficacy and Safety of Combination Drugs

• A study comparing a combination drug containing ambroxol, guaifenesin, and levosalbutamol to a fixed-dose combination of bromhexine/guaifenesin/salbutamol found that the combination drug had superior efficacy in treating productive cough in adult patients with acute bronchitis 4
• The study found that 70% of patients in the combination drug group had high or very high efficacy, compared to 44% in the reference drug group 4
• The safety profiles of the combination drug and the reference drug were comparable, with no statistically significant differences in the incidence of adverse events 4