What is the treatment for acute bronchitis?

Treatment for Acute Bronchitis

For immunocompetent adult outpatients with cough due to acute bronchitis, no routine antibiotics or medications should be prescribed, as the condition is primarily viral and self-limiting. 1, 2

Diagnosis and Evaluation

• Rule out pneumonia if any of these are present:

  • Heart rate >100 beats/min
  • Respiratory rate >24 breaths/min
  • Oral temperature >38°C
  • Chest examination findings of focal consolidation 2

• No routine investigations are needed, including:

  • Chest x-ray
  • Spirometry
  • Sputum cultures
  • Viral PCR
  • Inflammatory markers 1

Treatment Approach

Antibiotics

• Antibiotics are NOT recommended for routine treatment of acute bronchitis 1, 2
• 65-80% of patients receive antibiotics despite evidence they are ineffective 1
• Antibiotics provide minimal benefit (reducing cough by only about half a day) while causing potential harm 3

Exceptions for Antibiotic Use

• Pertussis (whooping cough): Macrolide antibiotic (erythromycin) is indicated
  • Patient should be isolated for 5 days from treatment start
  • Early treatment reduces coughing paroxysms and prevents disease spread 1, 2
• Consider antibiotics if bacterial infection is suspected when bronchitis worsens 1

Symptomatic Treatment

1. Antitussives:

   • Dextromethorphan can temporarily relieve cough due to bronchial irritation 4
   • Codeine preparations may have modest effect on cough severity 2

2. Expectorants:

   • Guaifenesin helps loosen phlegm and thin bronchial secretions 5

3. Bronchodilators:

   • β2-agonists (like albuterol) are NOT recommended for routine use 1
   • May be beneficial only in select patients with wheezing accompanying cough 1, 2

4. Other supportive measures:

   • Honey (one teaspoon) can relieve cough in viral bronchitis 2
   • Elimination of environmental cough triggers (dust, dander) 2
   • Vaporized air treatments in low-humidity environments 2

Patient Education

• Refer to the illness as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2
• Set realistic expectations for cough duration (typically 2-3 weeks) 2, 3
• Patient satisfaction depends more on quality of communication than receiving antibiotics 2, 6
• Explain the viral nature of the illness and risks of unnecessary antibiotic use:
  • Antibiotic resistance
  • Side effects
  • Allergic reactions 2

Common Pitfalls

• Overuse of antibiotics for acute bronchitis 2
• Failure to distinguish between acute bronchitis and pneumonia 2
• Not setting proper expectations about the natural course of illness 3
• Prescribing antibiotics due to patient pressure rather than clinical indication 6

Follow-up

• If cough persists or worsens, reassessment is recommended with consideration for targeted investigations:
  • Chest x-ray
  • Sputum for microbial culture
  • Peak expiratory flow measurements
  • Complete blood count
  • Inflammatory markers 1
• Consider alternative diagnoses such as asthma, as 65% of patients with recurrent acute bronchitis episodes were found to have mild asthma 1