What is the treatment for acute bronchitis?

From the Guidelines

Acute bronchitis treatment should primarily focus on symptom relief, with no routine prescription of antibiotic therapy, as most cases are viral and resolve within 1-3 weeks without antibiotics. The treatment approach should be individualized, considering the patient's symptoms and medical history. Over-the-counter medications like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can reduce fever and pain 1. A cough suppressant containing dextromethorphan may help control persistent coughing, especially at night. Staying well-hydrated with water, clear broths, or warm tea with honey helps thin mucus secretions and soothe the throat. Using a humidifier or taking steamy showers can also loosen congestion. Rest is essential to support your immune system's fight against the infection.

Some key considerations in managing acute bronchitis include:

• Avoiding routine investigations like chest x-ray, spirometry, or microbial cultures unless the condition worsens or persists 1
• Considering targeted investigations if the acute bronchitis persists or worsens, such as chest x-ray, sputum for microbial culture, or peak expiratory flow rate recording(s) 1
• Not routinely prescribing antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, or oral NSAIDs unless they have been shown to be safe and effective in making cough less severe or resolve sooner 1
• Considering treatment with antibiotic therapy if a complicating bacterial infection is thought likely, and differential diagnoses like exacerbations of chronic airways diseases should be considered 1

It's essential to note that the initial clinical evaluation is crucial in the longitudinal care of patients, and a retrospective study found that 65% of episodes of acute bronchitis were found to have mild asthma 1. Therefore, a thorough medical history and evaluation are necessary to guide the treatment approach and ensure the best possible outcomes for patients with acute bronchitis.

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

• The clinical cure rates for the bacteriologically evaluable patients by pathogen are:
  • S. pneumoniae: 91%
  • H. influenzae: 86%
  • M catarrhalis: 92%
• The most common side effects are 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 Acute Bronchitis

• Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting 3
• Therapy consists of both nonpharmacological and pharmacological options to include antibiotics and antivirals, antitussive agents, protussive agents, and beta-2-agonists 3
• Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia 4
• The supplement pelargonium may help reduce symptom severity in adults 4

Effectiveness of Treatments

• The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective 4
• Antibiotics for acute bronchitis have been associated with an approximately half-day reduction in duration of cough, but no significant differences in overall clinical improvement 5
• Other therapies targeted to control symptoms have also demonstrated a marginal or no effect 5

Recommendations for Clinical Practice

• Effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 4
• Clinicians should be aware of the marginal effectiveness of antibiotic therapy and consider strategies to reduce unnecessary utilization, such as rapid tests, delayed prescribing of antibiotics, and patient education 5