From the Guidelines
Acute bronchitis is typically a self-limiting condition that resolves within 1-3 weeks, and treatment should focus on symptom management rather than antibiotics, unless there is clear evidence of a bacterial infection. The most recent and highest quality study, 1, suggests that routine investigation with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin is not necessary for immunocompetent adult outpatients with cough due to suspected acute bronchitis.
Symptom Management
For symptom relief, over-the-counter medications like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can be used for fever and discomfort. A cough suppressant containing dextromethorphan may help with sleep if coughing is disruptive, while guaifenesin can help thin mucus. Staying well-hydrated, using a humidifier to moisten air, and avoiding smoking or secondhand smoke are also important.
Antibiotic Use
Antibiotics are generally not recommended for acute bronchitis unless there's clear evidence of a bacterial infection, as most cases are viral. According to 1, the presence of purulent sputum or a change in its color does not signify bacterial infection, and determining whether a patient has a viral or nonviral cause can be difficult.
When to Seek Medical Attention
If symptoms worsen, persist beyond three weeks, or if you experience high fever, difficulty breathing, or chest pain, seek medical attention promptly. People with underlying conditions like asthma, COPD, or weakened immune systems should consult their healthcare provider sooner as they may need additional treatment. As suggested by 1, differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should be considered if the acute bronchitis worsens.
Additional Considerations
Rest is important for recovery, and patients should be advised to seek reassessment and targeted investigation if the acute bronchitis persists or worsens, as recommended by 1. The initial clinical evaluation is important in the longitudinal care of patients, and in some cases, treatment with antibiotic therapy may be considered if a complicating bacterial infection is thought likely, as stated in 1.
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 clinical cure rate for azithromycin in the treatment of acute bacterial exacerbations of chronic bronchitis was 85% 2.
- The primary endpoint of the trial was the clinical cure rate at Day 21 to 24.
- Azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days).
- The most common side effects were diarrhea, nausea, and abdominal pain.
From the Research
Definition and Diagnosis of Acute Bronchitis
- Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia 3.
- The differential diagnosis includes exacerbations of preexisting conditions, such as asthma, chronic obstructive pulmonary disease, and heart failure or other causes of acute cough, including pertussis, COVID-19, influenza, and community-acquired pneumonia 4.
- Diagnostic testing is not indicated unless there is concern for other potential causes, such as community-acquired pneumonia, influenza, or COVID-19 4.
Symptoms and Duration of Acute Bronchitis
- Cough is the most common symptom of acute bronchitis, and it typically lasts about two to three weeks 3, 5.
- The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 5.
- Acute bronchitis is a self-limiting disease, and evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids 4.
Treatment and Management of Acute Bronchitis
- 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 3, 5.
- Antibiotics do not contribute to the overall improvement of acute bronchitis, although they may decrease the duration of cough by approximately 0.5 days, but their use exposes patients to antibiotic-related adverse effects 4.
- Symptom relief and patient education regarding the expected duration of cough (2-3 weeks) are recommended for the management of acute bronchitis 3, 4.
- Strategies shown to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold 3, 4.