What is the treatment for acute bronchitis?

Treatment of Acute Bronchitis

Antibiotics should not be prescribed for acute bronchitis unless pneumonia is suspected or there is confirmed pertussis infection. 1

Diagnosis and Assessment

Before initiating treatment, it's essential to distinguish acute bronchitis from other conditions:

• Acute bronchitis is a self-limited inflammation of the large airways characterized by cough with or without phlegm production lasting up to 3 weeks
• Rule out pneumonia, which is unlikely in the absence of:
  • Tachycardia (heart rate >100 beats/min)
  • Tachypnea (respiratory rate >24 breaths/min)
  • Fever (oral temperature >38°C)
  • Abnormal chest examination findings (rales, egophony, or tactile fremitus) 1

Treatment Algorithm

First-line: Symptomatic Treatment

1. Cough suppressants:

   • Dextromethorphan or codeine can be offered for short-term symptomatic relief 1
   • Most useful for disruptive cough, especially at night

2. Other symptomatic treatments that may provide relief:

   • Expectorants (guaifenesin)
   • First-generation antihistamines (diphenhydramine)
   • Decongestants (phenylephrine) 1

Bronchodilators

• Not recommended for routine use in uncomplicated acute bronchitis 1
• May be considered only in select patients with wheezing accompanying the cough 1
• β-agonists have not shown benefit for patients without asthma or COPD 1

Antibiotics

• Do not prescribe antibiotics for uncomplicated acute bronchitis 1
• Despite evidence against their use, 65-80% of patients with acute bronchitis receive antibiotics 1
• Exception: Confirmed or suspected pertussis (whooping cough)
  • Treat with a macrolide antibiotic (erythromycin) or trimethoprim/sulfamethoxazole if macrolides cannot be used
  • Isolate patient for 5 days from start of treatment 1

Patient Communication

When not prescribing antibiotics:

• Explain that acute bronchitis is primarily viral (>90% of cases) 1
• Clarify that purulent sputum (green or yellow) does not indicate bacterial infection 1
• Discuss potential harms of unnecessary antibiotics:
  • Adverse effects (increased risk compared to placebo) 1
  • Contribution to antibiotic resistance 1
• Set expectations about the natural course of illness (up to 3 weeks) 1

Common Pitfalls to Avoid

1. Misdiagnosing pneumonia as bronchitis: Always assess for signs of pneumonia using the clinical criteria mentioned above

2. Prescribing antibiotics based on patient expectation: Many patients expect antibiotics based on previous experiences; take time to explain why they aren't needed 1

3. Misinterpreting sputum color: Yellow or green sputum is due to inflammatory cells, not bacterial infection 1

4. Overlooking pertussis: Consider pertussis in patients with prolonged paroxysmal cough, especially during known community outbreaks 1

5. Overusing bronchodilators: These medications don't benefit most patients with acute bronchitis and may cause side effects like tremor and nervousness 1

Remember that acute bronchitis is self-limiting, and treatment should focus on symptom relief while avoiding unnecessary antibiotics that contribute to antibiotic resistance and potential adverse effects.