Do Not Prescribe Omnicef (Cefdinir) for Typical Viral Acute Bronchitis
Antibiotics, including Omnicef (cefdinir), should NOT be prescribed for uncomplicated acute bronchitis in otherwise healthy adults, regardless of cough duration, sputum color, or patient expectations. 1
Why Antibiotics Are Inappropriate
Respiratory viruses cause 89-95% of acute bronchitis cases, making antibiotics completely ineffective against the underlying cause. 1 The remaining 5-10% of cases involve atypical bacteria (Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Bordetella pertussis), not the typical bacteria that cephalosporins target. 1
Common encapsulated bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis do not cause acute bronchitis in adults without underlying lung disease. 1 Even though Omnicef has good activity against these organisms 2, they are not relevant pathogens in uncomplicated acute bronchitis.
Critical Diagnostic Pitfalls to Avoid
Purulent (green or yellow) sputum occurs in 89-95% of viral bronchitis cases and does NOT indicate bacterial infection. 1, 3 This is due to inflammatory cells and sloughed epithelial cells, not bacteria. Do not use sputum color as justification for antibiotics. 1
Cough duration does not indicate bacterial infection. Viral bronchitis cough typically lasts 10-14 days and may persist up to 3 weeks. 1, 3 Duration alone is not an indication for antibiotics. 1
Rule Out Pneumonia First
Before diagnosing acute bronchitis, exclude pneumonia by checking for ALL of the following: 1, 3
- Heart rate >100 beats/min
- Respiratory rate >24 breaths/min
- Oral temperature >38°C
- Abnormal chest examination findings (rales, egophony, tactile fremitus)
In healthy adults under 70 years, pneumonia is unlikely if ALL these criteria are absent. 1 If any are present, obtain chest radiography rather than treating as simple bronchitis. 1, 3
The Evidence Against Antibiotics
Antibiotics reduce cough duration by only 0.5 days (approximately 12 hours) while significantly increasing adverse events (RR 1.20; 95% CI 1.05-1.36). 1, 3 A randomized trial comparing amoxicillin-clavulanate to placebo showed no significant difference in days to cough resolution. 1
The FDA removed uncomplicated acute bronchitis as an indication for antimicrobial therapy in 1998 based on lack of efficacy. 1
The One Exception: Pertussis
If pertussis (whooping cough) is confirmed or strongly suspected, prescribe a macrolide antibiotic (azithromycin or erythromycin) immediately, not a cephalosporin like Omnicef. 1, 3 Patients should be isolated for 5 days from the start of treatment. 3
What TO Do Instead
Inform patients that cough typically lasts 10-14 days after the visit and may persist up to 3 weeks, even without antibiotics. 1, 3 Patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed. 1, 3
Consider symptomatic treatment only: 1, 3
- Antitussives (codeine or dextromethorphan) for bothersome dry cough, especially when disturbing sleep
- β2-agonist bronchodilators (albuterol) ONLY in select patients with accompanying wheezing
- Elimination of environmental cough triggers and humidified air
Instruct patients to return if: 3
- Fever persists >3 days (suggests bacterial superinfection or pneumonia)
- Cough persists >3 weeks (consider other diagnoses: asthma, COPD, pertussis, GERD)
- Symptoms worsen rather than gradually improve
Special Populations Requiring Different Approach
These guidelines apply ONLY to otherwise healthy adults without underlying lung disease. 1 Patients with COPD, chronic bronchitis, heart failure, immunosuppression, or age >75 years with comorbidities may require antibiotics and are beyond the scope of uncomplicated acute bronchitis management. 3