What is the treatment for acute bronchitis?

From the Guidelines

Treatment for acute bronchitis should focus on symptom relief, as most cases are viral and self-limiting, with no routine prescription of antibiotic therapy unless a complicating bacterial infection is thought likely. 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 until such treatments have been shown to be safe and effective.

Key Considerations

• Over-the-counter medications like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) can reduce fever and pain, as suggested by previous studies 1.
• A humidifier or steam inhalation can help loosen mucus and ease breathing.
• Staying hydrated by drinking plenty of fluids can thin secretions and facilitate expectoration.
• For cough management, dextromethorphan (15-30mg every 6-8 hours) can suppress coughing, while guaifenesin (200-400mg every 4 hours) helps thin mucus, although the evidence for these treatments is limited 1.
• Honey (1-2 teaspoons) can soothe throat irritation, especially before bedtime.

Important Notes

• Antibiotics are generally not recommended unless there's clear evidence of bacterial infection, as most cases are viral.
• Rest is essential to support recovery.
• If symptoms worsen, persist beyond three weeks, or include high fever, severe shortness of breath, or bloody mucus, medical attention should be sought immediately as these may indicate complications or a different condition requiring specific treatment.

Symptomatic Relief

• The use of symptomatic relief medications, such as cough suppressants and expectorants, should be individualized and based on the patient's specific symptoms and needs.
• The patient's response to treatment should be closely monitored, and adjustments made as necessary to ensure optimal symptom relief and minimize potential side effects.

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

• The primary treatment for acute bronchitis focuses on relieving symptoms, as the condition is usually caused by viruses 4, 5.
• Antibiotics are generally not recommended for acute bronchitis, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia, such as those 65 years or older 4, 6.
• Studies have shown that symptomatic treatments, including antitussives, anticholinergics, and honey, are often ineffective in reducing cough severity in adults with uncomplicated acute bronchitis 7.
• The use of supplements like pelargonium may help reduce symptom severity in adults 4.
• Patient satisfaction with treatment is often related to the quality of the physician-patient interaction rather than the prescription of antibiotics 5.

Management of Symptoms

• Cough is the most common symptom of acute bronchitis, and its management is crucial in treating the condition 4, 7.
• The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 4.
• Symptomatic treatments, such as protussives, antitussives, or bronchodilators, may be used to manage symptoms, but their effectiveness is often limited 5, 7.
• The U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 4.

Antibiotic Use

• Antibiotics have been associated with a marginal reduction in the duration of cough, but there are no significant differences in overall clinical improvement compared to placebo 6.
• The overuse of antibiotics contributes to the increasing problem of antibiotic resistance, and their use should be limited to cases where they are truly necessary 5, 6.
• Strategies such as rapid tests, delayed prescribing of antibiotics, and patient education have been associated with a reduction in unnecessary antibiotic use 6.