Treatment of Bronchitis
Antibiotics are NOT recommended for uncomplicated acute bronchitis, regardless of cough duration or sputum color. 1, 2
Acute Bronchitis Management
Initial Assessment
- Rule out pneumonia first by checking for tachycardia, tachypnea, fever >100.4°F, or asymmetrical lung sounds on examination 2, 3
- Chest radiography is unnecessary in healthy, nonelderly adults without vital sign abnormalities or asymmetrical lung findings 1, 2
- Viruses cause >90% of acute bronchitis cases, making antibiotics ineffective 1, 4
Symptomatic Treatment Options
- Short-acting β-agonists (albuterol) may reduce cough duration and severity in patients showing bronchial hyperresponsiveness or wheezing 2, 5, 3
- Ipratropium bromide may improve cough in some patients 2, 5, 3
- Dextromethorphan or codeine for short-term relief of bothersome cough only 2, 5, 3
What NOT to Use
- Expectorants and mucolytics lack evidence of benefit 2, 3
- Antihistamines, oral NSAIDs, and inhaled/oral corticosteroids are not effective 6
- Antibiotics expose patients to adverse effects while providing minimal benefit (only 0.5 days reduction in cough duration) 6
Rare Exception for Antibiotics
- Consider antibiotics only if pertussis is suspected with appropriate diagnostic testing 1
- Macrolide antibiotics should be given for confirmed pertussis with 5 days of isolation 1
Chronic Bronchitis Management
Foundation of Treatment
- Smoking cessation is the cornerstone of therapy, with 90% of patients experiencing cough resolution after quitting 2, 5
- Avoidance of all respiratory irritants is essential 2, 5
Pharmacologic Management
- Short-acting β-agonists to control bronchospasm and reduce chronic cough 2, 5, 3
- Ipratropium bromide should be offered to improve cough 2, 5, 3
- Long-acting β-agonists combined with inhaled corticosteroids for chronic cough control 2, 5, 3
- Inhaled corticosteroids for patients with FEV1 <50% predicted or frequent exacerbations 3
Acute Exacerbations of Chronic Bronchitis (AECB)
When to Treat with Antibiotics
Antibiotics ARE recommended for AECB, particularly in: 2, 5
- Patients with severe exacerbations
- Those with more severe baseline airflow obstruction
- Patients ≥65 years with fever 3
- Patients with cardiac failure 3
- Those with ≥1 key symptom (increased dyspnea, sputum production, or sputum purulence) AND ≥1 risk factor 7
Bronchodilator Therapy
Corticosteroid Therapy
What NOT to Use
- Theophylline is not recommended for acute exacerbations 2, 5, 3
- Long-term prophylactic antibiotics are not recommended in stable chronic bronchitis 5
Critical Communication Strategies
Setting Realistic Expectations
- Inform patients that cough typically lasts 10-14 days after the office visit (up to 3 weeks total) 3, 6
- Consider calling the illness a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 3
- Patient satisfaction depends more on quality of the clinical encounter than receiving antibiotics 1, 3
Discussing Antibiotic Risks
- Explain that antibiotics cause side effects and promote antibiotic resistance without meaningful benefit 3
- Emphasize that colored (green) sputum does NOT indicate bacterial infection—it results from inflammatory cells, not bacteria 3, 4
Common Pitfalls to Avoid
- Do not prescribe antibiotics based solely on colored sputum 2, 3
- Do not fail to distinguish acute bronchitis from pneumonia—check vital signs and lung examination 2, 3
- Do not overlook underlying conditions (asthma, COPD, cardiac failure, diabetes) that may be exacerbated 2, 3
- Do not use cough and cold preparations in children <6 years per FDA recommendations 4