What are the treatment differences between bronchitis and pneumonia?

Treatment Differences Between Bronchitis and Pneumonia

Acute bronchitis in healthy adults should NOT receive antibiotics, while pneumonia requires immediate antibiotic therapy for a minimum of 5 days. 1, 2, 3

Diagnostic Differentiation

The key to appropriate treatment is accurate diagnosis:

• Bronchitis presents with acute cough (often lasting 10-14 days), retrosternal burning, normal or diffuse bronchial sounds on auscultation, and a normal chest radiograph. 2, 3
• Pneumonia presents with fever >37.8°C, tachycardia >100 bpm, tachypnea >25/min, focal chest signs (crepitations/rales), and requires radiographic confirmation showing parenchymal infiltrates. 2, 3

Treatment for Acute Bronchitis

Antibiotics are NOT indicated for acute uncomplicated bronchitis in healthy adults. 1, 2, 3

• No benefit on clinical course or prevention of complications has been demonstrated in placebo-controlled trials. 3
• Short-acting β-agonists (albuterol) can be used for bronchospasm relief. 2
• Adequate hydration helps mobilize secretions. 2
• Dextromethorphan or codeine may be prescribed for bothersome dry cough. 1

Exception: COPD Exacerbations

Antibiotics ARE indicated for COPD exacerbations when patients have clinical signs of bacterial infection (increased sputum purulence PLUS increased dyspnea and/or increased sputum volume). 1

• Limit antibiotic duration to 5 days for COPD exacerbations with bacterial signs. 1
• Appropriate antibiotics include aminopenicillin with clavulanic acid, macrolides, or tetracyclines targeting H. influenzae, S. pneumoniae, and M. catarrhalis. 1

Treatment for Community-Acquired Pneumonia

Immediate antibiotic therapy is required for all confirmed pneumonia cases. 2, 3, 4

Outpatient Pneumonia (Healthy Adults Without Comorbidities)

• First-line: Amoxicillin 1g three times daily for 7 days. 2, 3, 4
• Alternative: Doxycycline 100mg twice daily. 4
• Macrolide monotherapy (azithromycin) only in areas where pneumococcal macrolide resistance is <25%. 4

Outpatient Pneumonia (With Comorbidities or Age >65)

• Preferred: Amoxicillin/clavulanate 875/125mg twice daily for 7 days OR combination therapy with amoxicillin plus macrolide. 2, 4
• Alternative: Respiratory fluoroquinolone (levofloxacin or moxifloxacin). 2

Hospitalized Non-Severe Pneumonia

• Preferred regimen: β-lactam (ceftriaxone 1-2g once daily or cefotaxime 1g three times daily) PLUS macrolide (azithromycin or clarithromycin) for 7-10 days. 2, 3, 4
• Most hospitalized patients can receive oral antibiotics if tolerated. 4

Severe Pneumonia (ICU-Level)

• Immediate IV combination therapy required: Non-antipseudomonal cephalosporin III (ceftriaxone 2g once daily or cefotaxime 1g three times daily) PLUS macrolide (clarithromycin or erythromycin) OR respiratory fluoroquinolone (levofloxacin 500-1000mg or moxifloxacin 400mg). 2, 3, 4
• Duration: 10-14 days, extending to 14-21 days for Legionella, staphylococcal, or gram-negative enteric bacilli. 4

Duration of Therapy

• Pneumonia minimum: 5 days, with extension guided by clinical stability markers (resolution of vital sign abnormalities, ability to eat, normal mentation). 1
• Standard pneumonia duration: 7-10 days for uncomplicated S. pneumoniae. 2, 4
• Bronchitis with antibiotics (COPD only): 5 days. 1

Critical Pitfalls to Avoid

• Never prescribe antibiotics for viral acute bronchitis in healthy adults—this promotes resistance without clinical benefit. 2, 3
• Do not use ciprofloxacin alone for pneumonia (inadequate pneumococcal coverage). 3
• Avoid azithromycin monotherapy for hospitalized moderate-risk pneumonia patients due to increasing pneumococcal resistance. 3
• If fever persists beyond 7 days in bronchitis, consider bacterial superinfection and reassess for pneumonia. 3

Non-Response Assessment

For pneumonia not improving within 48-72 hours, reassess for:

• Antimicrobial resistance or unusually virulent organisms. 1, 3
• Septic complications or wrong diagnosis. 1
• Obtain repeat chest radiograph, CRP, white cell count, and additional microbiological specimens. 3, 4

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