What is the treatment for bronchitis?

From the Guidelines

For immunocompetent adult outpatients with cough due to acute bronchitis, no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is recommended until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner. The treatment of bronchitis typically involves managing symptoms while the infection resolves.

Key Considerations

• For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) can help reduce fever and pain, as suggested by 1.
• A humidifier or steam from a hot shower can loosen mucus.
• Over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM) can be taken for severe coughing, while expectorants with guaifenesin (like Mucinex) help thin mucus.
• Antibiotics are generally not recommended for acute bronchitis as it's usually viral, but may be prescribed if bacterial infection is suspected, as noted in 1.

Chronic Bronchitis

• For chronic bronchitis, bronchodilators like albuterol (2 puffs every 4-6 hours as needed) or ipratropium may be prescribed to open airways, along with inhaled corticosteroids to reduce inflammation, as suggested by 1.
• Pulmonary rehabilitation, oxygen therapy, and smoking cessation are crucial for chronic cases.
• Most acute bronchitis cases resolve within 1-2 weeks, but chronic bronchitis requires ongoing management.

Treatment Goals

• Treatment works by reducing airway inflammation, thinning mucus secretions, and improving airflow through the bronchial tubes.
• The use of antibiotics for treatment of an acute exacerbation of chronic bronchitis is recommended as it has been shown to shorten the course of the illness, as noted in 1.

Important Considerations

• Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis) that may require other therapeutic management (such as with oral corticosteroids) should also be considered, as mentioned in 1.

From the FDA Drug Label

Adult PatientsAcute Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease In a randomized, double-blind controlled clinical trial of acute exacerbation of chronic bronchitis (AECB), azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days).

The primary endpoint of this trial was the clinical cure rate at Day 21 to 24 For the 304 patients analyzed in the modified intent to treat analysis at the Day 21 to 24 visit, the clinical cure rate for 3 days of azithromycin was 85% (125/147) compared to 82% (129/157) for 10 days of clarithromycin

Bronchitis treatment options include azithromycin.

• The clinical cure rate for azithromycin in the treatment of acute exacerbation of chronic bronchitis was 85% in one study 2.
• Azithromycin can be used to treat acute bacterial exacerbations of chronic obstructive pulmonary disease.
• The recommended dosage of azithromycin for this indication is 500 mg once daily for 3 days.

From the Research

Bronchitis Treatment Overview

• Bronchitis is a common diagnosis in primary care physician's offices, especially during winter 3.
• Acute bronchitis is usually caused by viruses, but other pathogens may also be responsible 3.
• Chronic bronchitis is characterized by prolonged sputum production and is most often caused by cigarette smoking 3.

Treatment Approaches

• Therapy for acute bronchitis is generally supportive 3.
• Antibiotics are not indicated for bronchitis, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia 4, 5.
• The use of cough and cold preparations in children younger than six years is not recommended by the U.S. Food and Drug Administration 4.
• The supplement pelargonium may help reduce symptom severity in adults 4.
• Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis 3.

Treatment Efficacy

• A systematic review found that antibiotics, antihistamines, antitussives, beta2 agonists, and expectorants/mucolytics have varying efficacy in treating acute bronchitis 6.
• A national survey of family physicians found that 63% of responding physicians indicated that antibiotics are their first choice of treatment for acute bronchitis in otherwise healthy adults 7.
• However, previous clinical trials have shown only marginal improvement in symptoms when patients with acute bronchitis are treated with an antibiotic 7, 5.

Patient Satisfaction and Communication

• Patient satisfaction with care for acute bronchitis depends most on physician-patient communication rather than on antibiotic treatment 5.
• Effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 4.