Augmentin Is Not Recommended for Acute Bacterial Bronchitis
Antibiotics, including Augmentin (amoxicillin-clavulanate), are not recommended for the treatment of acute bacterial bronchitis in immunocompetent adults. 1
Understanding Acute Bronchitis
Acute bronchitis is characterized by:
- Self-limited inflammation of the large airways
- Cough lasting up to 6 weeks
- Viral etiology in >90% of cases
- Clinical features including inconstant fever, retrosternal burning sensation, and normal auscultation or diffuse bronchial rales 2
Evidence Against Antibiotic Use in Acute Bronchitis
Microbiology Considerations
- Over 90% of acute bronchitis cases have a nonbacterial cause, primarily viral 1
- Only Bordetella pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae have been established as nonbacterial causes (accounting for only 5-10% of cases) 1
- No evidence indicates that Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis produces acute bronchitis in adults without underlying lung disease 1
Clinical Trial Evidence
- Systematic reviews of randomized controlled trials have found limited evidence to support antibiotic use for acute bronchitis 1
- Randomized, placebo-controlled trials have consistently failed to support a role for antibiotic treatment 1
- A randomized trial comparing ibuprofen, amoxicillin-clavulanic acid, and placebo showed no significant differences in days to cough resolution 1
Important Clinical Distinctions
Distinguishing Bronchitis from Pneumonia
Pneumonia is unlikely in the absence of all of the following:
- Tachycardia (heart rate >100 beats/min)
- Tachypnea (respiratory rate >24 breaths/min)
- Fever (oral temperature >38°C)
- Abnormal findings on chest examination (rales, egophony, or tactile fremitus) 1
Common Misconceptions
- Purulent sputum (yellow or green) does not signify bacterial infection; it is due to inflammatory cells or sloughed mucosal epithelial cells 1, 2
- The FDA has removed uncomplicated acute bronchitis as an indication for antimicrobial therapy 1
Appropriate Management of Acute Bronchitis
Recommended Symptomatic Relief
Patients may benefit from:
- Cough suppressants (dextromethorphan or codeine)
- Expectorants (guaifenesin)
- First-generation antihistamines (diphenhydramine)
- Decongestants (phenylephrine)
- β-agonists (only for patients with underlying asthma or COPD) 1
When to Consider Antibiotics
Antibiotics should only be considered if:
- The bronchitis worsens significantly
- A complicating bacterial infection is strongly suspected
- The patient has developed pneumonia (confirmed by chest X-ray) 1
FDA-Approved Indications for Augmentin
According to the FDA label, Augmentin is indicated for:
- Lower respiratory tract infections caused by beta-lactamase-producing isolates of Haemophilus influenzae and Moraxella catarrhalis
- Not specifically indicated for uncomplicated acute bronchitis 3
Conclusion
The evidence clearly shows that Augmentin (amoxicillin-clavulanate) should not be used for acute bacterial bronchitis in immunocompetent adults. Treatment should focus on symptomatic relief, with antibiotics reserved only for cases with strong evidence of bacterial pneumonia or other complications.