What is the recommended treatment for acute bronchitis?

Treatment of Acute Bronchitis

For patients with acute bronchitis, routine treatment with antibiotics is not justified and should not be offered, as acute bronchitis is primarily a viral illness. 1

Definition and Diagnosis

• Acute bronchitis is an acute respiratory infection with normal chest radiograph findings, manifested by cough with or without phlegm production lasting up to 3 weeks 1
• Respiratory viruses are the most common cause (89-95% of cases), with fewer than 10% of patients having bacterial infections 1, 2
• Pneumonia should be ruled out in patients with tachycardia (heart rate >100 beats/min), tachypnea (respiratory rate >24 breaths/min), fever (oral temperature >38°C), or abnormal chest examination findings (rales, egophony, or tactile fremitus) 1, 3

Antibiotic Treatment

• Antibiotics should not be routinely prescribed for acute bronchitis as they provide minimal benefit (reducing cough by only about half a day) while exposing patients to adverse effects 1, 4
• The presence of purulent sputum or a change in its color does not signify bacterial infection and is not an indication for antibiotics 1
• When patients expect antibiotics, clinicians should explain the decision not to use these agents and discuss the potential harm of unnecessary antibiotic use 1

Exception for Pertussis

• For confirmed or suspected pertussis (whooping cough), a macrolide antibiotic (such as erythromycin) should be prescribed 1
• Patients with pertussis should be isolated for 5 days from the start of treatment 1
• Early treatment within the first few weeks will diminish coughing paroxysms and prevent disease spread 1

Symptomatic Treatment

Bronchodilators

• β2-agonist bronchodilators should not be routinely used for cough in most patients with acute bronchitis 1
• In select adult patients with wheezing accompanying the cough, β2-agonist bronchodilators may be useful 1
• Patients with airflow obstruction at baseline may show some benefit from bronchodilators, but tremor, nervousness, and shakiness are more common in treatment groups 1

Antitussives

• Codeine or dextromethorphan may provide modest effects on severity and duration of cough in acute bronchitis 1, 5
• These central cough suppressants are recommended for short-term symptomatic relief of coughing 1, 3

Other Symptomatic Treatments

• Low-cost and low-risk actions such as elimination of environmental cough triggers and vaporized air treatments may be reasonable options 1
• There is insufficient evidence to support the use of expectorants, antihistamines, anticholinergics, NSAIDs, or inhaled/oral corticosteroids for acute bronchitis 5, 4
• Systemic corticosteroids are not justified in the treatment of acute bronchitis in healthy adults 5

Patient Education

• Inform patients that cough typically lasts 10-14 days after the office visit 1, 3
• Referring to the condition as a "chest cold" rather than bronchitis may reduce patient expectation for antibiotics 1
• Patient satisfaction with care depends more on physician-patient communication than whether an antibiotic is prescribed 1

Common Pitfalls

• Mistaking acute bronchitis for asthma exacerbation, pneumonia, or acute exacerbation of chronic bronchitis, which have different treatment approaches 5, 6
• Prescribing antibiotics based on purulent sputum, which is not an indication of bacterial infection 1, 5
• Using steroids in hopes of shortening illness duration, when evidence shows no benefit for this purpose in acute bronchitis 5

Acute bronchitis is a self-limiting disease, and treatment should focus on symptom relief and patient education rather than antibiotics or other medications that lack evidence of benefit.