What antibiotic is recommended for an adult with bronchitis lasting 10 days?

Bronchitis 10 Days: Antibiotic Recommendation

For uncomplicated acute bronchitis lasting 10 days in an otherwise healthy adult, antibiotics should NOT be prescribed, as they provide minimal benefit (reducing cough by only half a day) while causing significant adverse effects and contributing to antibiotic resistance. 1

Critical First Step: Rule Out Pneumonia

Before confirming bronchitis, you must exclude pneumonia by checking for:

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

If any of these are present, obtain chest radiography and treat as pneumonia, not bronchitis. 1

Why Antibiotics Don't Work for Acute Bronchitis

• Respiratory viruses cause 89-95% of acute bronchitis cases 1
• Multiple randomized controlled trials show no significant difference in cough duration, symptom scores, or clinical improvement between antibiotics and placebo 2
• Meta-analyses confirm antibiotics reduce cough by only 0.5 days over a 7-day period 2
• Purulent sputum does NOT indicate bacterial infection—it occurs in 89-95% of viral cases 1

What TO Do Instead

Patient Education

• Inform the patient that cough typically lasts 10-14 days after the visit, even without antibiotics, and may persist up to 3 weeks 1
• Explain that antibiotics expose them to adverse effects (diarrhea, nausea, rash) without providing benefit 1
• Patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed 1

Symptomatic Treatment

• Antitussives: Codeine or dextromethorphan may provide modest effects on severity and duration of cough, especially when dry cough is bothersome and disturbs sleep 1
• Bronchodilators: β2-agonist bronchodilators (albuterol) should only be used in select patients with accompanying wheezing 1
• Supportive measures: Elimination of environmental cough triggers and vaporized air treatments 1

The ONE Exception: Pertussis

If pertussis (whooping cough) is confirmed or strongly suspected, prescribe a macrolide antibiotic immediately:

• Azithromycin 500 mg on day 1, then 250 mg daily for 4 days 1
• OR Erythromycin 500 mg four times daily for 14 days 1
• Isolate the patient for 5 days from the start of treatment 1

When to Reassess

Instruct the patient to return if:

• Fever persists >3 days (suggests bacterial superinfection or pneumonia) 1
• Cough persists >3 weeks (consider other diagnoses: asthma, COPD, pertussis, GERD) 1
• Symptoms worsen rather than gradually improve 1

Special Populations Requiring Different Approach

These recommendations do NOT apply to:

• Patients with COPD or chronic bronchitis 1
• Immunocompromised patients 1
• Patients with cardiac failure, insulin-dependent diabetes, or serious neurological disorders 1

For these high-risk patients with acute exacerbation meeting Anthonisen criteria (increased dyspnea, increased sputum volume, increased sputum purulence), consider:

• Amoxicillin 500 mg three times daily for 5 days 3
• OR Doxycycline 100 mg twice daily for 5 days 3
• OR Amoxicillin-clavulanate 625 mg three times daily for 5 days 3

Common Pitfalls to Avoid

• Don't prescribe antibiotics based on cough duration alone—viral bronchitis cough normally lasts 10-14 days 1
• Don't prescribe antibiotics based on purulent sputum—this occurs in 89-95% of viral cases 1
• Don't assume bacterial infection before the 3-day fever threshold—most cases are viral 1
• Don't diagnose "recurrent acute bronchitis" without ruling out asthma—approximately one-third of these patients actually have undiagnosed asthma 1