What are the treatment options for bronchitis?

From the Guidelines

Treatment for bronchitis should prioritize managing symptoms and avoiding respiratory irritants, with a focus on bronchodilators, inhaled corticosteroids, and smoking cessation for chronic cases, as supported by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.

Key Treatment Options

• For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen or ibuprofen can help reduce fever and relieve pain.
• Over-the-counter cough suppressants containing dextromethorphan and expectorants with guaifenesin can help control coughing and thin mucus.
• Antibiotics are generally not recommended for acute bronchitis since it's usually viral, but may be prescribed if bacterial infection is suspected.

Chronic Bronchitis Management

• Bronchodilators like albuterol, inhaled corticosteroids, and sometimes oral steroids like prednisone may be prescribed for chronic bronchitis.
• Pulmonary rehabilitation, oxygen therapy for severe cases, and smoking cessation are crucial components of treatment.
• Avoidance of respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards, is the most effective means to improve or eliminate the cough of chronic bronchitis, with 90% of patients experiencing resolution of their cough after smoking cessation 1.

Antibiotic Use

• The use of antibiotics for treatment of an acute exacerbation of chronic bronchitis is recommended, especially in patients with purulent sputum and more severe illness, as it has been shown to shorten the course of the illness 1.
• However, therapy with antibiotics is currently not recommended for stable patients with chronic bronchitis due to concerns about antibiotic resistance and potential side effects.

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 options for bronchitis include azithromycin (500 mg once daily for 3 days) and clarithromycin (500 mg twice daily for 10 days), with clinical cure rates of 85% and 82%, respectively, at Day 21 to 24 2.

• Key treatment options:
  • Azithromycin
  • Clarithromycin
• Clinical cure rates:
  • Azithromycin: 85%
  • Clarithromycin: 82%

From the Research

Treatment Options for Bronchitis

• The treatment for bronchitis depends on the type and severity of the condition, as well as the presence of any underlying health conditions 3, 4, 5.
• For acute bronchitis, symptoms typically last about three weeks, and antibiotics are generally not indicated unless pertussis is suspected or the patient is at increased risk of developing pneumonia 3.
• The supplement pelargonium may help reduce symptom severity in adults with acute bronchitis 3.
• For chronic bronchitis, treatment typically includes pulmonary hygiene, bronchodilators, and antimicrobial therapy 4.
• In cases of acute exacerbations of chronic bronchitis, antibiotics such as azithromycin, amoxicillin/clavulanate, or gemifloxacin may be prescribed 4, 5, 6.
• The choice of antibiotic depends on the severity of the exacerbation and the presence of any underlying health conditions, as well as the risk of antibacterial resistance 5, 6.

Antibiotic Treatment

• Azithromycin has been shown to be effective in treating acute lower respiratory tract infections, including acute bronchitis and acute exacerbations of chronic bronchitis 4, 7.
• Amoxicillin/clavulanate and gemifloxacin are also effective treatments for acute exacerbations of chronic bronchitis 5, 6.
• The use of antibiotics should be reserved for patients with at least one key symptom and one risk factor, such as increased dyspnea, sputum production, or purulence, and underlying health conditions such as age > 65 years or forced expiratory volume in 1 second < 50% of the predicted value 5.

Supportive Care

• Supportive care, including removal of irritants, use of a bronchodilator, oxygen, hydration, and chest physical therapy, should be provided to all patients with bronchitis 5.
• Systemic corticosteroids may also be used to reduce inflammation and improve symptoms in patients with acute exacerbations of chronic bronchitis 5.