What is the best medication for acute bronchitis?

Best Medication for Acute Bronchitis

Do not prescribe antibiotics for acute bronchitis—they provide no meaningful clinical benefit and expose patients to unnecessary harm. 1

Primary Treatment Approach

Symptomatic management is the standard of care for acute bronchitis. The condition is viral in over 90% of cases and self-limited, with cough typically lasting 10-14 days. 1, 2

What NOT to Prescribe

• Antibiotics are contraindicated in uncomplicated acute bronchitis. They reduce cough duration by only half a day while causing significant adverse effects including diarrhea, nausea, and contributing to antibiotic resistance. 1, 3
• Purulent or colored sputum does NOT indicate bacterial infection and is not a reason to prescribe antibiotics—this represents inflammatory cells, not bacteria. 1
• Macrolides (azithromycin) cause more adverse events than placebo in acute bronchitis patients. 1
• β-agonists should not be routinely prescribed for most patients with acute bronchitis, as they provide no benefit in those without underlying asthma or COPD. 1, 2

What TO Consider for Symptom Relief

For patients with wheezing or evidence of bronchial hyperresponsiveness:

• Albuterol may reduce cough duration and severity in select patients with wheezing accompanying their cough. 1, 2
• Approximately 50% fewer patients report cough after 7 days when treated with albuterol versus placebo. 1

For bothersome cough:

• Dextromethorphan or codeine may provide modest symptomatic relief for cough severity and duration. 1, 4
• These agents are recommended only for short-term use. 1, 4

Other supportive measures:

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

Critical Exclusions Before Diagnosis

Rule out pneumonia if ANY of these are present:

• Heart rate >100 beats/min 1
• Respiratory rate >24 breaths/min 1
• Oral temperature >38°C 1
• Abnormal chest examination findings (rales, egophony, tactile fremitus) 1

If these criteria are absent in healthy adults under 70 years, pneumonia is unlikely and chest radiography is not needed. 1

The ONE Exception: Pertussis

If pertussis (whooping cough) is confirmed or strongly suspected, prescribe a macrolide antibiotic such as erythromycin. 2

• Isolate patients for 5 days from treatment start. 2
• Early treatment within the first few weeks diminishes coughing paroxysms and prevents disease spread. 2

Patient Communication Strategy

Patient satisfaction depends on communication quality, not antibiotic prescription. 1, 2

Key counseling points:

• Inform patients cough typically lasts 10-14 days after the visit. 1, 2
• Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations. 1, 2
• Explain that antibiotics cause side effects (diarrhea, nausea, rash) and contribute to antibiotic resistance without improving outcomes. 1, 2
• Discuss the viral nature of the illness (>90% of cases). 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics over the phone—examination is necessary to exclude pneumonia. 5
• Do not use colored sputum as justification for antibiotics—this is inflammatory debris, not bacterial infection. 1, 4
• Do not prescribe β-agonists routinely—reserve for patients with wheezing or known bronchial hyperresponsiveness. 1, 2, 4
• Avoid NSAIDs at anti-inflammatory doses or systemic corticosteroids—these are not beneficial in acute bronchitis. 2