What is the treatment for acute bronchitis?

From the Guidelines

Acute bronchitis treatment primarily focuses on symptom management as most cases are viral and self-limiting. For symptom relief, recommend over-the-counter medications like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours for fever and pain, as suggested by 1. A cough suppressant containing dextromethorphan (such as Robitussin DM) can be used for severe cough, especially at night. Encourage rest, adequate hydration, and use of a humidifier to loosen mucus.

Key Considerations

• Antibiotics are generally not recommended for uncomplicated acute bronchitis since 90% of cases are viral, as stated in 1 and 1.
• If bacterial infection is suspected (persistent symptoms beyond 10-14 days, purulent sputum, fever >100.4°F), amoxicillin 500mg three times daily for 5-7 days or azithromycin 500mg on day 1 followed by 250mg daily for 4 days may be considered, as mentioned in 1.
• For patients with underlying COPD or asthma, short-acting bronchodilators like albuterol (2 puffs every 4-6 hours as needed) may help with wheezing and shortness of breath, as noted in 1.

Symptom Management

• Over-the-counter medications for symptom relief
• Rest and adequate hydration
• Use of a humidifier to loosen mucus
• Cough suppressants for severe cough

Antibiotic Use

• Generally not recommended for uncomplicated acute bronchitis
• May be considered if bacterial infection is suspected

Special Considerations

• Patients with underlying COPD or asthma may require additional treatment, such as short-acting bronchodilators, as mentioned in 1.
• Most cases resolve within 1-3 weeks, but the cough may persist for up to 4 weeks, as stated in 1.

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 for acute bronchitis (specifically acute bacterial exacerbations of chronic bronchitis) is azithromycin (500 mg once daily for 3 days) as it has been shown to have a clinical cure rate of 85% in a randomized, double-blind controlled clinical trial 2.

From the Research

Treatment Overview

The treatment for acute bronchitis is primarily symptomatic, as the condition is usually caused by a virus 3, 4, 5, 6, 7.

Symptomatic Treatment

• A sore throat is treated locally 3
• A troublesome cough, especially at night, is treated with antitussive agents for a limited period (14 days) 3
• If bronchial mucus is viscous and difficult to clear, short-term treatment with a secretolytic or mucolytic substance is justified 3
• Protussives, antitussives, or bronchodilators may be used for symptomatic treatment 5, 7

Antibiotic Use

• Antibiotics are not indicated in patients without chronic lung disease, as they provide only minimal benefit and have adverse effects 4, 6
• Antibiotics 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) 6
• Antibiotics have been shown to be ineffective in patients with uncomplicated acute bronchitis and contribute to the increasing problem of antibiotic resistance 4, 7

Patient Education

• Patients should be educated about the natural course of the disease, which typically lasts about two to three weeks 4, 6
• Patients should be informed about the lack of benefit of antibiotics in treating acute bronchitis and the potential risks of their use 4, 6, 7