From the Guidelines
For bronchitis that hasn't improved with amoxicillin, switch to a broader-spectrum antibiotic like doxycycline or azithromycin, as recommended by the most recent guidelines 1. Prescribe doxycycline 100 mg twice daily for 5-7 days, or azithromycin 500 mg on day 1, followed by 250 mg daily for 4 days. Additionally:
- Use an inhaled bronchodilator like albuterol, 2 puffs every 4-6 hours as needed, to help reduce inflammation and improve airflow 1.
- Add an inhaled corticosteroid like fluticasone, 2 puffs twice daily, to reduce airway inflammation and improve symptoms 1.
- Recommend rest, increased fluid intake, and use of a humidifier to aid in symptom relief and recovery.
- For cough relief, suggest an over-the-counter expectorant like guaifenesin, although its effectiveness is not well-established 1. These treatments target both bacterial infection and airway inflammation, with doxycycline or azithromycin providing broader coverage against potential pathogens resistant to amoxicillin, as suggested by the French guidelines 1. If symptoms persist or worsen after this treatment, further evaluation may be necessary to rule out other conditions or complications, and consideration of other treatment options, such as oral corticosteroids, may be needed 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 exacerbation of bronchitis unresponsive to Amoxicillin is azithromycin (500 mg once daily for 3 days) or clarithromycin (500 mg twice daily for 10 days), as both have been shown to be effective in clinical trials 2.
- Key points:
- Azithromycin has a clinical cure rate of 85% at Day 21 to 24.
- Clarithromycin has a clinical cure rate of 82% at Day 21 to 24.
- Both treatments have comparable incidence rates of treatment-related adverse events, primarily gastrointestinal.