What is the treatment for bronchitis?

From the Guidelines

The treatment for bronchitis should focus on managing symptoms, reducing airway inflammation, and preventing complications, with the most effective approach being avoidance of respiratory irritants, such as smoking cessation, and the use of bronchodilators, inhaled corticosteroids, and pulmonary rehabilitation. For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help reduce fever and relieve pain, as suggested by 1. A humidifier or steam from a hot shower can loosen mucus, and over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM) may help control coughing, especially at night. Some key points to consider in the treatment of bronchitis include:

• Avoidance of respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards, which is the most effective way to reduce or eliminate cough in patients with chronic bronchitis, as stated in 1.
• Therapy with a short-acting inhaled β-agonist, inhaled ipratropium bromide, and oral theophylline, and a combined regimen of inhaled long-acting β-agonist and an inhaled corticosteroid may improve cough in patients with chronic bronchitis, as mentioned in 1.
• For the treatment of an acute exacerbation of chronic bronchitis, there is evidence that inhaled bronchodilators, oral antibiotics, and oral corticosteroids (or in severe cases IV corticosteroids) are useful, as indicated in 1 and 1.
• Smoking cessation is crucial as continued smoking worsens the condition, and oxygen therapy may be necessary in severe cases, as noted in 1. The goal of treatment is to reduce airway inflammation, facilitate mucus clearance, and prevent complications while the body fights the underlying cause, with the most recent and highest quality evidence guiding the treatment approach, as seen in 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 for bronchitis is azithromycin (500 mg once daily for 3 days), with a clinical cure rate of 85% at Day 21 to 24, as compared to clarithromycin (500 mg twice daily for 10 days) with a clinical cure rate of 82%.

• Key points:
  • Azithromycin is used to treat acute bacterial exacerbations of chronic obstructive pulmonary disease.
  • The clinical cure rate for azithromycin was 85% at Day 21 to 24.
  • The most common side effects were diarrhea, nausea, and abdominal pain. 2

From the Research

Treatment Options for Bronchitis

• The treatment for bronchitis typically involves a combination of supportive care and, in some cases, antibiotic therapy 3.
• Supportive care may include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy 3.
• Antibiotic treatment should be reserved for patients with at least one key symptom (e.g., increased dyspnea, sputum production, sputum purulence) and one risk factor (e.g., age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value, > or = 4 AECBs in 12 months, 1 or more comorbidities) 3.

Antibiotic Therapy

• A newer macrolide, extended-spectrum cephalosporin, or doxycycline is appropriate for an exacerbation of moderate severity, and high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone should be used for a severe exacerbation 3.
• Azithromycin has been shown to be effective in reducing acute exacerbations of chronic obstructive pulmonary disease (AECOPD) 4, 5.
• A comparative study found that azithromycin and amoxicillin/clavulanic acid were equally effective in the treatment of lower respiratory tract infections, including acute bronchitis and pneumonia 6.

Non-Antibiotic Treatment

• For acute bronchitis, symptoms typically last about three weeks, and viruses are responsible for more than 90 percent of infections 7.
• 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 (e.g., patients 65 years or older) 7.
• The supplement pelargonium may help reduce symptom severity in adults with acute bronchitis 7.