Bronchitis%20-%20uncomplicated%20acute Treatment
Pharmacotherapy
- Routine use of antibiotics is highly discouraged and should only be considered in patients with bacterial infection or pneumonia; consider local resistance patterns when planning use of antibiotics
Choice of therapy depends on which symptoms are most bothersome to the patient
Analgesics (Non-Opioid) and Antipyretics
- Eg Paracetamol, Ibuprofen
- Beneficial when influenza symptoms eg malaise and fever are prominent
- Avoid salicylates in children ≤18 years of age because of the risk of Reye Syndrome
Bronchodilators: Beta2-Agonists
- Eg Albuterol
- May be used to reduce the duration and severity of cough in some patients, but routine use for cough palliation is not recommended
- Use should be individualized to those who are most likely to benefit
- Justified in patients with clinical evidence of airflow obstruction or bronchial hyperresponsiveness (eg wheezing or bothersome cough)
- Studies have shown that more patients report decrease in cough after 7 days of inhaled bronchodilator as compared to placebo or antibiotic
Cough and Cold Preparations
- Codeine or Dextromethorphan
- May be justified for a nonproductive irritating cough, given short term for cough relief
- Codeine is a weak, centrally acting opioid that suppresses cough
- Dextromethorphan is a non-opioid that acts centrally to decrease cough
- Patients with cough lasting >2-3 weeks are the most likely to benefit
- Suppress the cough reflex by a direct action on the cough center in the medulla of the brain
- Modest effect on severity and duration of cough
- Typically not very effective in patients with acute or early cough due to colds or other viral upper respiratory tract infection (URTI)
- May be justified for a nonproductive irritating cough, given short term for cough relief
- Though evidence is lacking to recommend mucolytic monotherapy for acute bronchitis, studies show changes in the character of sputum and improvement in respiratory symptoms with its use
- Guaifenesin is an expectorant which acts by stimulating respiratory tract secretions leading to increased fluid volumes and decreased mucus viscosity
- Also have antitussive activity
- Effectiveness in reducing cough frequency and intensity was shown in several clinical trials
Other Treatments
- Pelargonium sidoides
- May be used as monotherapy or in combination with symptomatic therapy and/or antibiotics
- Modulates immune response, has bacteriostatic properties preventing proliferation of bacteria that causes secondary bacterial superinfection and has expectorant and mucolytic properties
- Reduces duration and severity of respiratory tract infections caused by viruses
- Vitex negundo L. (Lagundi leaf)
- Studies show improvement of respiratory symptoms with Lagundi treatment when compared with Theophylline
Antibiotics for Pertussis
- Use is supported only for confirmed or suspected B pertussis cases when there is a high probability of exposure or during an outbreak
- Erythromycin is the drug of choice for treatment and prophylaxis of pertussis in people of all ages
- Two small comparative studies suggest that Clarithromycin and Azithromycin are at least as effective as Erythromycin for pertussis treatment
- Co-trimoxazole may be used as an alternative when macrolides cannot be given
- Antibiotics are primarily used to decrease shedding of the pathogen and therefore decrease the spread of the disease
- Patient isolation for 5 days from the start of treatment is a necessary precaution
- Antibiotic therapy does not appear to resolve symptoms if it is initiated 7-10 days after the onset of illness but does prevent spread to others