Bronchitis Management Guidelines

Acute Bronchitis

The American College of Physicians recommends that antibiotics should NOT be prescribed for acute bronchitis, as they reduce cough duration by only 0.5 days while exposing patients to adverse effects and contributing to antibiotic resistance 1
Patient education is crucial, informing patients that cough typically lasts 10-14 days after the visit, with complete resolution within 3 weeks 1
Antitussives, such as codeine or dextromethorphan, provide modest symptom relief for bothersome dry cough, especially disturbing sleep 1, 2
Bronchodilators, such as β2-agonist bronchodilators, should NOT be routinely used, except in select patients with accompanying wheezing 1
Expectorants, mucolytics, antihistamines, inhaled corticosteroids, oral corticosteroids, and NSAIDs at anti-inflammatory doses have no proven benefit 1

The American Thoracic Society recommends ipratropium bromide as the first-line therapy to improve cough, with a Grade A recommendation 3, 4, 2
Ipratropium bromide reduces cough frequency, cough severity, and sputum volume 3, 4
Short-acting β-agonists may be used to control bronchospasm and relieve dyspnea, and may also reduce chronic cough in some patients 3, 5
Theophylline may be considered for chronic cough control, but requires careful monitoring for complications 3, 5
Inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) may be added for patients with FEV1 <50% or frequent exacerbations 3, 5, 4

The American College of Chest Physicians recommends administering short-acting β-agonists or anticholinergic bronchodilators during acute exacerbations; if no prompt response, add the other agent at maximal dose 3, 5
Systemic corticosteroids are recommended for acute exacerbations, with a 10-15 day course 2, 5
Antibiotics should be reserved for patients with ≥1 key symptom (increased dyspnea, sputum volume, or sputum purulence) AND ≥1 risk factor, such as age ≥65 years, FEV1 <50% predicted, or comorbidities 1
Doxycycline, clarithromycin extended-release, and clarithromycin immediate-release are recommended antibiotic regimens for moderate severity exacerbations 1
Amoxicillin/clavulanate and respiratory fluoroquinolone may be used for severe exacerbations 1