Bronchitis%20-%20uncomplicated%20acute Treatment

• 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)

• 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