What are the treatment options for acute 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, or oral NSAIDs is suggested until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner. This approach is based on the most recent and highest quality study available, which emphasizes the importance of avoiding unnecessary treatments that may not provide significant benefits and could potentially cause harm 1.

Key Considerations

• The primary goal in treating acute bronchitis is to manage symptoms and support the body's natural recovery process.
• Most cases of acute bronchitis are viral in nature and will resolve on their own within 1-2 weeks without the need for antibiotics.
• Antibiotics should only be considered if there is a high likelihood of a complicating bacterial infection, as suggested by the expert panel report 1.
• Patients should be advised to rest, increase fluid intake, and use over-the-counter medications like acetaminophen or ibuprofen for symptom relief.
• A humidifier or steam inhalation can help loosen mucus, and cough relief medications like dextromethorphan or guaifenesin may be useful for short-term symptomatic relief.

Special Considerations

• Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should be considered and may require alternative therapeutic management, including the use of oral corticosteroids.
• Smoking cessation is crucial for patients with chronic bronchitis, as smoking can worsen symptoms and delay recovery.
• Medical attention should be sought if symptoms worsen, breathing becomes difficult, or fever persists beyond 3 days, as these may indicate complications such as pneumonia.

The approach to treating bronchitis should prioritize symptom management and avoid unnecessary treatments, as supported by the most recent evidence 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

The treatment for bronchitis is azithromycin (500 mg once daily for 3 days), with a clinical cure rate of 85% at Day 21 to 24 2.

• Key points:
  • Clinical cure rate: 85% for azithromycin
  • Treatment duration: 3 days
  • Dosage: 500 mg once daily
• Common side effects: diarrhea, nausea, and abdominal pain, with comparable incidence rates for each symptom of 5 to 9% between the two treatment arms.

From the Research

Treatment Options for Bronchitis

• The primary approach to treating bronchitis, especially acute bronchitis, is supportive, focusing on symptom management rather than curing the condition itself 3, 4.
• Antibiotics are generally not recommended for acute bronchitis unless there is a suspicion of pertussis or the patient is at an increased risk of developing pneumonia, such as those 65 years or older 3, 4.
• For chronic bronchitis, antimicrobial agents and vaccines may play both prophylactic and therapeutic roles in management, especially in cases where cigarette smoking is a factor 5.
• Symptom relief and patient education on the expected duration of cough (typically 2-3 weeks) are key components of managing acute bronchitis 4.
• Strategies to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold 4.

Specific Therapies

• The use of azithromycin has been explored in the treatment of acute exacerbations of COPD, which includes chronic bronchitis, with a focus on short-duration therapy 6.
• Supplements like pelargonium may help reduce symptom severity in adults with acute bronchitis 3.
• Evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids for acute bronchitis 4.
• Systematic reviews have evaluated the efficacy of various interventions, including antibiotics, antihistamines, antitussives, beta2 agonists, and expectorants/mucolytics, for acute bronchitis in people without chronic respiratory disease 7.