From the Guidelines
For immunocompetent adult outpatients with cough due to acute bronchitis, no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is recommended until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner. This approach is based on the most recent and highest quality study available, which suggests that these treatments should not be used routinely for acute bronchitis in immunocompetent adults 1.
Key Considerations
- The treatment of acute bronchitis should focus on managing symptoms and supporting the body's natural recovery process.
- Antibiotics should only be considered if there is evidence of a complicating bacterial infection, as suggested by the expert panel report 1.
- For chronic bronchitis, treatment may include bronchodilators, inhaled corticosteroids, and possibly oral steroids during flare-ups, as well as smoking cessation and pulmonary rehabilitation to improve quality of life.
Treatment Approach
- Rest, increased fluid intake, and over-the-counter medications like acetaminophen or ibuprofen can help manage symptoms of acute bronchitis.
- A humidifier can help loosen mucus, and cough suppressants may provide relief at night.
- For chronic bronchitis, treatments like albuterol, fluticasone, and prednisone may be used to reduce airway inflammation and improve breathing, as supported by earlier guidelines 1. However, the most recent guidance from 1 should take precedence in the treatment of acute bronchitis.
Prioritizing Patient Outcomes
- The primary goal of treatment should be to reduce morbidity, mortality, and improve quality of life for patients with bronchitis.
- Treatment decisions should be based on the most recent and highest quality evidence available, with a focus on minimizing unnecessary medication use and promoting supportive care.
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 of bronchitis with azithromycin has a clinical cure rate of 85% when administered at 500 mg once daily for 3 days.
- The most common side effects were diarrhea, nausea, and abdominal pain, with comparable incidence rates for each symptom of 5 to 9% between the two treatment arms 2.
- Key pathogens treated with azithromycin include S. pneumoniae, H. influenzae, and M. catarrhalis, with clinical cure rates ranging from 86% to 92% 2.
From the Research
Treatment of Bronchitis
The treatment of bronchitis can be divided into two main categories: acute and chronic bronchitis.
- Acute bronchitis is usually caused by viruses, and therapy is generally supportive 3.
- Chronic bronchitis, on the other hand, is characterized by prolonged sputum production and is most often caused by cigarette smoking 4.
Pharmacological Interventions
Pharmacological interventions for bronchitis include:
- Expectorants and mucolytics, such as guaifenesin, which help loosen mucus in the airways and make coughs more productive 5, 6.
- Long-acting beta2-adrenergic receptor agonists, anticholinergics, glucocorticoids, phosphodiesterase-4 inhibitors, antioxidants, and antibiotics 5.
- Guaifenesin has a well-established and favorable safety and tolerability profile in adult and pediatric populations, and is considered a safe and effective expectorant for the treatment of mucus-related symptoms in acute upper respiratory tract infections and stable chronic bronchitis 6.
Non-Pharmacological Measures
Non-pharmacological measures for the treatment of bronchitis include:
- Smoking cessation, which can help decrease mucociliary transport velocity and reduce the risk of exacerbations 4.
- Chest physiotherapy, which can help increase mucus clearance and improve lung function 5.
Antibiotic Use
Antibiotics are generally not indicated for bronchitis, and should only be used if pertussis is suspected or if the patient is at increased risk of developing pneumonia 3.