From the Guidelines
For acute bronchitis, the most effective treatment approach is to manage symptoms while the body fights the infection, with a focus on rest, increased fluid intake, and over-the-counter medications like acetaminophen or ibuprofen to reduce fever and pain, as recommended by the most recent guidelines 1. The treatment of acute bronchitis should prioritize symptom management and supportive care.
Key Treatment Considerations
- Rest and increased fluid intake are essential for helping the body recover from the infection.
- Over-the-counter medications such as acetaminophen (325-650mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours) can help reduce fever and alleviate pain 1.
- A humidifier or steam inhalation can be beneficial in loosening mucus and relieving cough.
- Over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM, 10-20mg every 4 hours) may help control coughing, particularly at night.
- For productive coughs, guaifenesin (Mucinex, 600-1200mg every 12 hours) can thin mucus, making it easier to expel.
Antibiotic Use
- Antibiotics are not typically recommended for acute bronchitis as it is usually viral in nature, but may be prescribed if a complicating bacterial infection is suspected or in cases of chronic bronchitis exacerbations 1.
Additional Considerations
- Smoking cessation is crucial for patients with bronchitis, as continued smoking can worsen the condition and delay recovery.
- Most cases of acute bronchitis resolve within 1-2 weeks, but the cough may persist for several weeks.
- It is essential to seek medical attention if symptoms worsen, breathing becomes difficult, or fever persists beyond three days. The decision not to use antibiotics should be addressed individually, and explanations should be offered to patients, as many expect to receive an antibiotic based on previous experiences and public expectation 1.
From the Research
Treatment Options for Acute Bronchitis
- The treatment of acute bronchitis depends on the causative pathogen and the presence or absence of underlying lung disease 2.
- For patients with acute bronchitis, symptoms typically last about three weeks, and viruses are responsible for more than 90 percent of infections 3.
- 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) 3.
- Broad spectrum antibiotics are appropriate in selected patients, such as those with underlying lung disease or frequent exacerbations 4, 5.
- The supplement pelargonium may help reduce symptom severity in adults 3.
Antibiotic Therapy
- Antibiotic therapy should be used in patients with underlying lung disease, frequent exacerbations, and comorbid conditions 5.
- Penicillins, erythromycin, beta-lactamase inhibitors, and trimethoprim-sulfamethoxazole have been the preferred antibiotics, but new generation macrolides and fluoroquinolones should be the first line of treatment in selected patients due to increasing prevalence of resistance among respiratory pathogens 5.
- Ampicillin is effective, safe, economical, and thus remains the drug of choice for acute bacterial exacerbations of chronic bronchitis, while quinolones are an effective alternative when ampicillin cannot be tolerated or if organisms are resistant 6.
Symptomatic Treatment
- Simple bronchitis is best treated symptomatically 4.
- The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 3.
- Physiotherapy, bronchodilators, and other background therapies may accompany antimicrobial therapy 6.