What is the treatment for bronchitis?

Treatment of Acute Bronchitis

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 and contributing to antibiotic resistance. 1, 2

Initial Assessment and Diagnosis

Before treating for acute bronchitis, rule out pneumonia by checking for:

• Tachycardia (heart rate >100 beats/min) 2
• Tachypnea (respiratory rate >24 breaths/min) 2
• Fever (oral temperature >38°C) 2
• Abnormal chest examination findings (rales, egophony, tactile fremitus) 2

No routine investigations are recommended including chest x-ray, spirometry, sputum culture, viral PCR, or inflammatory markers (CRP, procalcitonin) at initial presentation. 1

Symptomatic Treatment Approach

First-Line Therapy: Bronchodilators

Albuterol (short-acting β2-agonist) is the recommended first-line symptomatic treatment for patients with evidence of bronchial hyperresponsiveness such as wheezing or bothersome cough. 3

• Approximately 50% fewer patients report cough after 7 days of albuterol treatment compared to placebo 1, 3
• Treatment reduces both duration and severity of cough 1, 3
• Do NOT routinely use β2-agonists in patients without wheezing or clinical evidence of bronchial hyperresponsiveness 2, 4

Second-Line: Antitussives

For patients with persistent bothersome cough:

• Dextromethorphan or codeine provide modest effects on cough severity and duration 1, 2, 4
• These agents are more effective for cough lasting >3 weeks or cough associated with underlying lung disease 1

Adjunctive Measures

Low-cost, low-risk interventions are reasonable:

• Elimination of environmental cough triggers (dust, dander) 1, 3
• Vaporized air treatments, particularly in low-humidity environments 1, 3

When Antibiotics Are NOT Indicated

The presence of purulent sputum or change in sputum color does NOT signify bacterial infection and is NOT an indication for antibiotics. 2

Antibiotics reduce cough duration by only approximately 0.5 days while causing side effects and promoting resistance. 5

Exception: When to Consider Antibiotics

Pertussis (Whooping Cough)

• Prescribe a macrolide antibiotic (erythromycin) for confirmed or suspected pertussis 2
• Isolate patients for 5 days from start of treatment 2, 4
• Early treatment within first few weeks diminishes coughing paroxysms and prevents spread 2

Worsening Bronchitis

• Consider antibiotics only if the condition significantly worsens, suggesting bacterial superinfection 1, 3
• Reassess and consider targeted investigations if symptoms persist or worsen 1

Influenza-Related Bronchitis

• Consider antiviral agents if within 48 hours (preferably <30 hours) of symptom onset during documented influenza outbreaks 1, 2

Patient Communication Strategy

Patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed. 1, 2

Key Points to Discuss:

• Inform patients that cough typically lasts 10-14 days after the office visit 2, 3, 4
• Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2, 4
• Explain the lack of benefit of antibiotics for uncomplicated acute bronchitis 1, 2
• Discuss potential harm of unnecessary antibiotic use including side effects and contribution to resistance 2, 4

Common Pitfalls to Avoid

• Do not prescribe antibiotics based solely on colored or purulent sputum 2, 4
• Do not routinely use NSAIDs at anti-inflammatory doses or systemic corticosteroids for acute bronchitis 2, 4
• Do not fail to distinguish between acute bronchitis and pneumonia before initiating treatment 4
• Do not overlook bronchodilator therapy which has demonstrated benefit in appropriate patients 3