What is the treatment for bronchitis?

Treatment for Bronchitis

Antibiotics should not be routinely prescribed for acute bronchitis, as they provide minimal benefit (reducing cough by only about half a day) while exposing patients to adverse effects including allergic reactions, nausea, and Clostridium difficile infection. 1, 2

Initial Assessment

Before treating bronchitis, rule out pneumonia by checking for:

• Heart rate >100 beats/min
• Respiratory rate >24 breaths/min
• Oral temperature >38°C
• Focal chest examination findings (rales, egophony, tactile fremitus) 1, 3

Critical pitfall: Purulent or colored sputum occurs in 89-95% of viral bronchitis cases and does NOT indicate bacterial infection or need for antibiotics. 1, 4

Symptomatic Management

For Acute Bronchitis (Cough <3 weeks)

Recommended approaches:

• Patient education that cough typically lasts 10-14 days, with most symptoms resolving within 3 weeks 1, 2
• Refer to the condition as a "chest cold" rather than bronchitis to reduce antibiotic expectations 1, 5
• Codeine or dextromethorphan may provide modest short-term relief for bothersome dry cough 1, 6

β2-agonist bronchodilators (e.g., albuterol):

• Should NOT be routinely used 1, 3
• May be considered only in select patients with wheezing accompanying the cough 1, 6

Do NOT use:

• Expectorants or mucolytics (lack evidence of benefit) 1, 6
• Antihistamines 5
• Inhaled or oral corticosteroids 5
• NSAIDs at anti-inflammatory doses 1

When Antibiotics ARE Indicated

Suspected Pertussis (Whooping Cough)

Prescribe a macrolide antibiotic (erythromycin or azithromycin) if: 7, 1

• Cough persisting >2-3 weeks with paroxysmal cough, whooping, or post-tussive emesis
• Documented exposure during pertussis outbreak
• Isolate patient for 5 days from start of treatment 1
• Early treatment diminishes coughing paroxysms and prevents disease spread 1

Suspected Bacterial Superinfection

Consider antibiotics only if: 1, 3

• Fever >38°C persists beyond 3 days
• Significant clinical worsening occurs
• Patient is high-risk (age ≥65 years, immunocompromised, or comorbidities like COPD, heart failure, diabetes)

If antibiotics are warranted, use: 1

• Amoxicillin 500 mg three times daily for 5-8 days, OR
• Doxycycline 100 mg twice daily for 7-10 days, OR
• Azithromycin 500 mg daily for 3 days 8

Chronic Bronchitis Management

For patients with chronic bronchitis (cough with sputum ≥3 months/year for ≥2 consecutive years): 6

Cornerstone therapy:

• Smoking cessation (90% experience resolution of cough) 6
• Avoidance of respiratory irritants 6

Bronchodilator therapy:

• Short-acting β-agonists to control bronchospasm 6
• Ipratropium bromide to improve cough 6
• Long-acting β-agonists combined with inhaled corticosteroids for chronic cough control 6

Acute Exacerbations of Chronic Bronchitis

Antibiotics ARE recommended for acute exacerbations, particularly if: 6, 9

• Severe exacerbations present
• More severe airflow obstruction at baseline
• Patient has risk factors: age >65, FEV1 <50%, recurrent exacerbations, or comorbidities

Treatment regimen: 6

• Short-acting β-agonists or anticholinergic bronchodilators
• Antibiotics (see regimens above)
• Short course (10-15 days) of systemic corticosteroids 6

Communication Strategy

To maintain patient satisfaction while avoiding unnecessary antibiotics: 1, 2

• Explain that antibiotics do not improve viral bronchitis and cause harm
• Emphasize that patient satisfaction depends more on physician-patient communication than antibiotic prescribing
• Discuss risks of unnecessary antibiotic use: side effects and antibiotic resistance
• Consider delayed antibiotic prescription strategy (prescription to fill only if symptoms worsen after 3 days) 5