From the Guidelines
Antibiotics are not recommended for treating uncomplicated acute bronchitis.
Treatment Approach
- For patients with uncomplicated acute bronchitis, routine antibiotic treatment is not justified 1.
- The focus should be on clinically ruling out serious illness, particularly pneumonia 2.
- Analgesics and antipyretics can be used to relieve symptoms, even though they will not shorten the duration of illness 2.
- Antiviral agents may be considered for patients with influenza, but they must be initiated within 48 hours of symptom onset and their use should be weighed against the potential for viral resistance and high cost 2.
Special Considerations
- For patients with chronic bronchitis, antibiotics may be recommended for acute exacerbations, especially in those with purulent sputum, greater severity of illness, and more severe airflow obstruction at baseline 3.
- Elderly patients or those with comorbid conditions such as chronic obstructive pulmonary disease, congestive heart failure, or immunosuppression may require different management approaches, and specific patient and epidemiologic circumstances should be taken into account 2.
From the Research
Treatment Options for Bronchitis
- Antibiotics may be modestly effective for a minority of patients with acute bronchitis, but it is not clear which patient subgroups might benefit 4
- Antibiotics are not necessary for every patient with acute bronchitis, and their use should be limited to cases with convincing evidence of a bacterial infection 5
- Symptomatic treatment with protussives, antitussives, or bronchodilators is often appropriate for acute bronchitis, as the condition is usually caused by a viral infection 6
Antibiotic Use in Bronchitis
- Antibiotics have generally been shown to be ineffective in patients with uncomplicated acute bronchitis, and their overuse contributes to the increasing problem of antibiotic resistance 6
- The use of antibiotics in bronchitis has been associated with adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection 7
- Macrolide antibiotics are the therapy of first choice for 'atypical' pathogens, such as Legionella, Mycoplasma, or Chlamydia spp. 8
Non-Antibiotic Treatments for Bronchitis
- Albuterol has been shown to have an impressive advantage over erythromycin in the treatment of acute bronchitis 5
- Patient education and symptomatic treatment are important components of the management of acute bronchitis, and can help to reduce unnecessary antibiotic use 7
- Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold 7