What is the treatment for acute 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 acute bronchitis, rule out pneumonia by checking for:

• Tachycardia (heart rate >100 beats/min) 1
• Tachypnea (respiratory rate >24 breaths/min) 1
• Fever (oral temperature >38°C) 1
• Abnormal chest examination findings (rales, egophony, or tactile fremitus) 1

Important caveat: The presence of purulent or green/yellow sputum does NOT indicate bacterial infection and is NOT an indication for antibiotics—this discoloration is due to inflammatory cells or sloughed mucosal epithelial cells, not bacteria. 1, 2

Primary Treatment Approach: Symptomatic Management

Cough Suppressants

For symptomatic relief, consider:

• Dextromethorphan for temporary relief of cough due to bronchial irritation 3, 1
• Codeine may provide modest effects on cough severity and duration 1
• Guaifenesin to help loosen phlegm and thin bronchial secretions 4

Bronchodilators

β2-agonist bronchodilators (like albuterol) should NOT be routinely used for most patients with acute bronchitis. 1, 5

However, in select adult patients with wheezing accompanying the cough, β2-agonist bronchodilators may be useful. 5, 1 This represents a subgroup that showed benefit in clinical trials—patients with baseline airflow obstruction and wheezing at illness onset. 5

Additional Supportive Measures

• Elimination of environmental cough triggers 1
• Vaporized air treatments 1
• These low-cost, low-risk interventions are reasonable options 1

The Pertussis Exception: When Antibiotics ARE Indicated

For confirmed or suspected pertussis (whooping cough), prescribe a macrolide antibiotic such as erythromycin. 5, 1, 2

Pertussis management requires:

• Macrolide antibiotic (erythromycin preferred; trimethoprim/sulfamethoxazole if macrolides cannot be given) 5
• Isolation for 5 days from the start of treatment 5, 1
• Early treatment (within the first few weeks) to diminish coughing paroxysms and prevent disease spread 5, 1

Suspect pertussis when cough persists >2 weeks with paroxysmal cough, whooping cough, post-tussive emesis, or recent pertussis exposure. 6

Influenza-Related Bronchitis

Consider antiviral agents if influenza-related bronchitis is diagnosed within 48 hours of symptom onset. 1

Patient Communication Strategy

Critical for patient satisfaction and reducing inappropriate antibiotic expectations:

• Inform patients that cough typically lasts 10-14 days after the office visit 1, 2
• Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1, 2
• Explain that patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed 1, 2
• Discuss the risks of unnecessary antibiotic use, including side effects (nausea, vomiting, allergic reactions, Clostridium difficile infection) and contribution to antibiotic resistance 1, 2

Medications to AVOID

Do NOT use:

• NSAIDs at anti-inflammatory doses 1
• Systemic corticosteroids 1

Special Populations

These guidelines apply to otherwise healthy adults. Different management approaches may be needed for:

• Elderly patients 2
• Patients with COPD, congestive heart failure, or immunosuppression 1, 2
• These patients may require individualized assessment for bacterial superinfection 1

Note: In smokers without COPD, there is no evidence that antibiotics are more beneficial than in non-smokers. 2