From the Guidelines
Acute bronchitis should be managed with symptom relief measures, and antibiotics should not be prescribed unless there is clear evidence of bacterial infection, as they do not affect the clinical course of viral respiratory infections. The management of acute bronchitis primarily focuses on relieving symptoms while the infection resolves naturally. For acute bronchitis, which is typically viral, treatment includes rest, adequate hydration, and over-the-counter medications like acetaminophen or NSAIDs for fever and discomfort, as suggested by 1. A humidifier can help loosen mucus, and honey (1-2 teaspoons) may reduce cough, especially in adults and children over one year.
According to the most recent guidelines, antibiotics are generally not recommended for acute bronchitis unless there's clear evidence of bacterial infection, such as pneumonia 1. For patients with clinical signs of a bacterial infection, such as increased sputum purulence, antibiotics like an aminopenicillin with clavulanic acid, a macrolide, or a tetracycline may be prescribed for a short course of 5 days, as recommended by 1.
Some key points to consider in the management of acute bronchitis include:
- Providing realistic expectations for the duration of cough (10 to 14 days after office visit) and referring to the cough illness as a chest cold rather than bronchitis, as suggested by 1
- Personalizing the risk of unnecessary antibiotic use and informing patients that previous antibiotic use increases their likelihood of carriage of and infection with antibiotic-resistant bacteria, as noted by 1
- Focusing on patient-physician communication to improve patient satisfaction with the office visit, rather than relying on antibiotic prescriptions, as indicated by 1
From the Research
Management of Acute Bronchitis
The management of acute bronchitis typically involves symptomatic treatment, as the condition is usually caused by a virus 2, 3, 4, 5, 6.
- The use of antibiotics is generally not indicated, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia 2.
- Symptomatic treatment may include the use of antitussive agents, protussive agents, and beta-2-agonists to manage cough and other symptoms 3, 4, 6.
- In some cases, the use of secretolytic or mucolytic substances may be justified to help clear bronchial mucus 3.
- The supplement pelargonium may also help reduce symptom severity in adults 2.
- Nonpharmacological options, such as supportive care, may also be recommended 5, 6.
Treatment Approaches
Different treatment approaches may be taken depending on the specific circumstances of the patient, such as:
- The presence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 2.
- Patient expectations for antibiotics and therapies for symptom management may differ from evidence-based recommendations, highlighting the need for effective communication strategies 2, 4.
- The management of chronic bronchitis, which is often caused by cigarette smoking, may involve the elimination of noxae and treatment with antibiotics in cases of infection-driven exacerbation 3, 5.