From the Guidelines
For acute bronchitis, the most effective treatment approach is to manage symptoms while the infection resolves, without routine prescription of antibiotics, unless a complicating bacterial infection is suspected 1. The treatment of acute bronchitis typically involves:
- Rest and increased fluid intake to help the body recover
- Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) at standard doses to reduce fever and discomfort
- A humidifier or steam inhalation to loosen mucus
- Cough relief medications such as dextromethorphan (Robitussin DM) or guaifenesin (Mucinex) may be effective, but their use should be guided by the latest evidence and clinical judgment 1 Key considerations in the management of acute bronchitis include:
- Avoiding unnecessary antibiotic use, as most cases are viral in nature 1
- Identifying and managing underlying conditions, such as asthma or chronic obstructive pulmonary disease (COPD), which may require different treatment approaches 1
- Providing patient education on symptom management, including the use of over-the-counter medications and non-pharmacologic interventions like humidifiers and steam inhalation
- Encouraging smoking cessation, as continued smoking can irritate the bronchial tubes and prolong healing 1 It is essential to seek medical attention if symptoms worsen, breathing becomes difficult, or fever persists beyond three days, as these may indicate a complicating infection or other underlying condition requiring prompt medical attention.
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 options for acute bronchitis include azithromycin (500 mg once daily for 3 days) and clarithromycin (500 mg twice daily for 10 days).
- The clinical cure rate for 3 days of azithromycin was 85% compared to 82% for 10 days of clarithromycin 2.
- The most common side effects were diarrhea, nausea, and abdominal pain with comparable incidence rates for each symptom of 5 to 9% between the two treatment arms 2.
From the Research
Treatment Options for Acute Bronchitis
The treatment options for acute bronchitis depend on the causative pathogen and the presence or absence of underlying lung disease 3.
- Antibiotic Therapy: Antibiotics are recommended for patients with underlying lung disease, frequent exacerbations, and comorbid conditions 4, 5. The preferred antibiotics include penicillins, erythromycin, beta-lactamase inhibitors, and trimethoprim-sulfamethoxazole 4. However, due to increasing resistance among respiratory pathogens, new generation macrolides and fluoroquinolones are recommended as the first line of treatment in selected patients 4.
- Symptomatic Treatment: Symptomatic treatment is recommended for acute bronchitis, including local treatment of a sore throat and antitussive agents for a troublesome cough 6. Secretolytic or mucolytic substances may be used for a short period to help clear bronchial mucus 6.
- Exclusion of Underlying Conditions: It is essential to exclude pneumonia or an exacerbation of underlying chronic bronchitis before treating acute bronchitis 7.
- Broad-Spectrum Antibiotics: Broad-spectrum antibiotics are appropriate in selected patients, particularly those with an exacerbation of chronic bronchitis 7.
Antibiotic Selection
The choice of antibiotic depends on the suspected or confirmed pathogen, with common bacterial etiologies including Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae 4, 5. Ampicillin is effective, safe, and economical, making it a suitable option for acute bacterial exacerbations of chronic bronchitis 5. Quinolones are an effective alternative when ampicillin cannot be tolerated or if organisms are resistant 5.