From the Guidelines
Management of Acute Bronchitis
Acute bronchitis management typically involves symptomatic relief with over-the-counter medications such as acetaminophen (650-1000mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours) for cough and chest discomfort 1.
- Antibiotics are not recommended for routine use, but may be considered in cases of suspected bacterial infection, with azithromycin (500mg on day 1, followed by 250mg daily for 4 days) or amoxicillin-clavulanate (875/125mg twice daily for 7-10 days) being potential options 1.
- Cough suppression with dextromethorphan (15-30mg every 4-6 hours) may also be used, but its effectiveness is limited 1.
- β-Agonists, such as albuterol, may be beneficial in reducing the duration and severity of cough in some patients, particularly those with bronchial hyperresponsiveness 1.
- Other symptomatic relief options include expectorants (guaifenesin), first-generation antihistamines (diphenhydramine), and decongestants (phenylephrine) 1. It is essential to distinguish acute bronchitis from pneumonia, as the presence of purulent sputum or a change in its color does not signify bacterial infection 1. Key considerations in management include:
- Patient education on the nature of the illness and the lack of benefit from antibiotics in most cases 1.
- Individualized treatment based on the patient's specific symptoms and medical history 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 management of acute bronchitis may include the use of azithromycin (500 mg once daily for 3 days) as an effective treatment option, with a clinical cure rate of 85% at Day 21 to 24.
- The most common side effects were diarrhea, nausea, and abdominal pain.
- The clinical cure rates for bacteriologically evaluable patients by pathogen were:
- S. pneumoniae: 91%
- H. influenzae: 86%
- M. catarrhalis: 92% 2
From the Research
Management of Acute Bronchitis
The management of acute bronchitis typically involves symptomatic treatment, as the condition is often self-limiting 3. The goals of treatment are to relieve symptoms, such as cough, and improve quality of life.
Treatment Options
- Nonpharmacological options: No specific nonpharmacological options are mentioned in the provided studies.
- Pharmacological options:
- Antibiotics: Azithromycin is no better than low-dose vitamin C for acute bronchitis 4. However, antibiotics such as cephalosporins, macrolides, and amoxicillin plus beta-lactamase-inhibitor may be effective for bacterial infections of the lower respiratory tract 5.
- Antivirals: No specific antiviral treatments are mentioned in the provided studies.
- Antitussive agents: Codeine was no more effective than placebo in reducing cough symptoms, while dextromethorphan showed mixed results 6.
- Expectorants: Guaifenesin was found to be helpful in reducing cough symptoms in adults, but the evidence is limited 7, 6.
- Beta-2-agonists: Albuterol inhaler was reported to be beneficial by most patients (81%) 4.
Special Considerations
- Viral infections: Acute bronchitis is often caused by viral infections, and antibiotics are not effective against viral infections 3, 5.
- Bacterial infections: Antibiotics may be effective for bacterial infections of the lower respiratory tract, but the choice of antibiotic depends on the suspected pathogen and local resistance patterns 5.
- Underlying conditions: Patients with underlying lung disease or other conditions may require different treatment approaches 5, 4.