From the Guidelines
The treatment for acute bronchitis primarily focuses on symptom management, and antibiotics are generally not recommended unless there's clear evidence of a bacterial infection, as most cases are viral. The most recent and highest quality study, 1, published in 2016, recommends against routine antibiotic treatment in the absence of pneumonia. This study found limited evidence to support the use of antibiotics for acute bronchitis and a trend toward increased adverse events in patients treated with antibiotics.
Some key points to consider in the management of acute bronchitis include:
- Rest, adequate hydration, and over-the-counter medications like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 4-6 hours can help manage fever and pain.
- For cough relief, dextromethorphan (found in Robitussin DM) 10-20mg every 4 hours or guaifenesin (Mucinex) 200-400mg every 4 hours can be effective, as suggested by 1.
- Using a humidifier or taking steamy showers may help loosen mucus.
- Patients with underlying conditions like asthma or COPD may need inhaled bronchodilators such as albuterol (2 puffs every 4-6 hours as needed) to help with breathing, as noted in 1.
- Smoking cessation is crucial as it can worsen symptoms and delay recovery.
It's essential to distinguish acute bronchitis from pneumonia, and the absence of certain clinical criteria, such as tachycardia, tachypnea, fever, and abnormal findings on a chest examination, can help reduce the likelihood of pneumonia, as stated in 1. If symptoms persist beyond three weeks, worsen significantly, or if you develop high fever, difficulty breathing, or chest pain, seek medical attention promptly.
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% 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
The treatment for acute bronchitis typically involves symptomatic relief, as the condition is often self-limiting and caused by viral infections 3. The following are some treatment options:
- Nonpharmacological options: These may include rest, hydration, and avoiding irritants such as smoke 3.
- Pharmacological options: These may include:
Use of Antibiotics
The use of antibiotics in acute bronchitis is a topic of debate. Some studies suggest that antibiotics may provide a small benefit in reducing the duration of symptoms, but this benefit must be weighed against the risks of side effects and antibiotic resistance 4. Other studies recommend that antibiotics be reserved for cases where there is a high suspicion of bacterial infection 6.
Symptomatic Treatment
Symptomatic treatment is often the primary approach for managing acute bronchitis. This may include the use of bronchodilators, antitussives, and protussives to relieve symptoms such as cough and shortness of breath 3, 5. Patient satisfaction with treatment is often related to the quality of the physician-patient interaction rather than the prescription of antibiotics 5.
Special Considerations
In certain cases, such as in infants and young children with acute viral bronchiolitis, supportive care including administration of oxygen and fluids may be necessary 7. The use of bronchodilators, corticosteroids, and other medications may not be effective in these cases, and their use should be approached with caution 7.