What is the treatment for bronchitis?

From the Guidelines

The treatment for bronchitis typically involves managing symptoms while the infection resolves, with a focus on avoiding unnecessary antibiotic use, as recommended by the most recent guidelines 1. For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) at standard doses can help reduce fever and discomfort.

• A humidifier or steam inhalation may loosen mucus and ease breathing.
• Over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM, 10-20 mg every 4 hours) can help control coughing, particularly at night. Antibiotics are generally not recommended for acute bronchitis as it's usually viral, unless there's evidence of bacterial infection, as suggested by the expert panel report 1. For chronic bronchitis, bronchodilators like albuterol (2 puffs every 4-6 hours as needed) may be prescribed to open airways, along with inhaled corticosteroids to reduce inflammation, as recommended by the ACCP evidence-based clinical practice guidelines 1. Pulmonary rehabilitation, smoking cessation, and oxygen therapy might be necessary for severe cases. Treatment duration varies—acute bronchitis typically resolves in 1-3 weeks, while chronic bronchitis requires ongoing management. Seeking medical attention is important if symptoms worsen, breathing becomes difficult, or fever persists beyond three days. It's also crucial to consider the patient's overall health and potential underlying conditions, such as COPD or asthma, which may require different management strategies, as noted in the guidelines 1.

From the FDA Drug Label

Acute Bacterial Exacerbations of Chronic Bronchitis 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). Acetylcysteine is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: Chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis and primary amyloidosis of the lung) Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)

The treatment for bronchitis may include antibiotics such as azithromycin (2) for acute bacterial exacerbations, and mucolytics like acetylcysteine (3) as adjuvant therapy to help loosen and clear mucus from the airways.

• Azithromycin is used to treat acute bacterial exacerbations of chronic bronchitis.
• Acetylcysteine is used to help loosen and clear mucus from the airways in conditions such as chronic bronchopulmonary disease and acute bronchopulmonary disease, including bronchitis.

From the Research

Treatment for Bronchitis

The treatment for bronchitis depends on the type and severity of the condition.

• For acute bronchitis, symptoms typically last about three weeks, and viruses are responsible for more than 90 percent of infections 4.
• 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) 4.
• In acute bronchitis, in otherwise healthy adults, the preference is to not prescribe an antibiotic, but if prescribed, a newer macrolide for those under age 50 or a short course of cefuroxime for patients over age 50, especially if they are "healthy smokers" 5.
• For chronic bronchitis, prevention of further damage to the airways should be attempted by instituting a program of smoking cessation and appropriate immunizations against influenza and pneumococcus 5.
• Treatment outcomes will also improve if congestive heart failure is recognized as a potential cause of progressing shortness of breath, cough, and increasing sputum production, rather than infection alone 5.

Antibiotic Therapy

• Antibiotic therapy 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) 6.
• 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 6.
• Antibiotics may be modestly effective for a minority of patients with acute bronchitis, but it is not clear which patient subgroups might benefit 7.

Supportive Care

• Supportive care should be provided to all patients with bronchitis, which might include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy 6.
• Corticosteroid drugs may be effective in treating patients with chronic bronchitis, especially those with sputum eosinophilia 8.