From the Guidelines
Treatment for acute bronchitis should focus on symptom relief, with no routine prescription of antibiotic therapy, as most cases are viral and self-limiting. The most recent and highest quality study, published in 2020 1, suggests that immunocompetent adult outpatients with cough due to acute bronchitis should not receive routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, or oral NSAIDs.
Symptom Relief Measures
Some measures that can help alleviate symptoms include:
- Over-the-counter medications like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours to reduce fever and pain
- Cough management with dextromethorphan (found in Robitussin DM) 10-20mg every 4 hours or guaifenesin (Mucinex) 600-1200mg every 12 hours
- Staying well-hydrated, using a humidifier, and getting plenty of rest as essential supportive measures
Antibiotic Use
Antibiotics are generally not recommended for uncomplicated acute bronchitis, but may be prescribed if there's evidence of bacterial infection or in patients with underlying lung disease, as suggested by a study published in 2016 1.
Monitoring and Follow-up
Symptoms typically improve within 1-2 weeks, though the cough may persist for up to 3-4 weeks. If symptoms worsen, include high fever (>101°F), shortness of breath, or chest pain, or if you have underlying conditions like COPD or asthma, seek medical attention promptly as more targeted treatment may be needed. A study published in 2001 1 highlights the importance of individualized treatment and the potential benefits of bronchodilators in patients with uncomplicated acute bronchitis.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants The treatment for acute bronchitis may include guaifenesin (PO) to help loosen phlegm and thin bronchial secretions, and dextromethorphan (PO) to temporarily relieve cough due to minor throat and bronchial irritation 2 3.
- Key points:
- Guaifenesin helps make coughs more productive
- Dextromethorphan relieves cough due to minor throat and bronchial irritation
From the Research
Treatment Options for Acute Bronchitis
- Symptomatic treatment is the primary approach for managing acute bronchitis, as it is usually caused by a virus 4, 5, 6.
- Treatment may include:
- Antibiotics are generally not indicated for acute bronchitis, except in cases of suspected pertussis or increased risk of developing pneumonia (e.g., patients 65 years or older) 5, 7.
Use of Expectorants and Bronchodilators
- Expectorants containing salbutamol, bromhexine, and guaiphenesin may be effective in alleviating productive cough associated with acute bronchitis 8.
- A combination of salbutamol, bromhexine, and guaiphenesin was found to be more effective than salbutamol with either bromhexine or guaiphenesin alone in reducing cough frequency and severity 8.
Antibiotic Therapy
- The benefits and risks of antibiotics for acute bronchitis remain unclear, despite it being one of the most common illnesses seen in primary care 7.
- A systematic review found that antibiotics may have a modest beneficial effect in some patients, but the magnitude of this benefit needs to be considered in the context of potential side effects and increased resistance to respiratory pathogens 7.
- Antibiotic-treated participants were more likely to experience adverse effects, with a significant trend towards an increase in adverse effects in the antibiotic group 7.