Bronchitis is the medical term for inflammation of the airways. The illness typically produces a persistent cough that may be accompanied by fever, breathing discomfort and production of phlegm. The illness may be short term, known as "acute" bronchitis, or long term, known as "chronic" bronchitis. Most cases of bronchitis should not be treated with antibiotics. Your doctor will advise you about the best course of treatment to minimize your risk of unnecessary exposure to antibiotics and their potential side effects.
Acute, Uncomplicated Bronchitis
More than 90 percent of cases of acute bronchitis are caused by viruses, the Centers for Disease Control and Prevention reports. Because antibiotics are not effective against viruses, CDC recommends that most cases of acute bronchitis should not be treated with antibiotics. Acute bronchitis and pneumonia may produce some similar symptoms, so your doctor will examine you. If she hears no pneumonia-like sounds when listening to your chest and you have no underlying chronic disease, she will likely recommend treatment that does not include antibiotics. That decision can be reliably made based on your symptoms and physical examination; a chest x-ray is not required. Ask questions about fluids, diet and use of fever reducers and cough medicine. It is not in your best interest to press for an antibiotic prescription if your doctor has determined that this type of medicine is not needed.
Acute Bronchitis vs. Pneumonia
A cough accompanied by a fever greater than 100.4 degrees Fahrenheit, a breathing rate of more than 23 per minute, a pulse greater than 99 beats per minute or abnormal chest findings on physical examination may indicate pneumonia rather than acute bronchitis. Your doctor may order a chest x-ray to help determine whether you have pneumonia. If pneumonia is diagnosed or suspected, your doctor will likely prescribe an antibiotic. Medicines commonly used in these circumstances are azithromycin (Zithromax), clarithromycin (Biaxin) and erythromycin.
Persistent Acute Bronchitis
According to a study published in June 2011 in "Clinical Evidence," symptoms of acute bronchitis last for an average of 11 days, but the cough may persist for as long as 3 weeks. Twenty percent of people treated without antibiotics return to the doctor with persistent or worsening symptoms within a month of their first visit. In these cases, your doctor may suspect a bacterial rather than a viral infection and prescribe an antibiotic. She may order a chest x-ray and other tests to determine the exact cause of your symptoms.
Acute Worsening of Chronic Bronchitis
Chronic bronchitis is a form of chronic obstructive pulmonary disease, or COPD. Coughing occurs most days over a prolonged period and is accompanied by decreased movement of air through the airways. Antibiotics are only indicated when coughing worsens significantly and phlegm becomes pus-like. Mild cases may be treated with the same antibiotics as acute bronchitis. More severe cases may be treated with a single antibiotic, such as levofloxacin (Levaquin) or in combination with a second drug, such as amoxicillin-clavulanate (Augmentin). Hospitalization is sometimes necessary to support breathing until the flareup resolves.
- The Merck Manual for Health Care Professionals: Acute Bronchitis
- Clinical Evidence: Bronchitis (Acute)
- PLoS ONE: A Sustainable Strategy to Prevent Misuse of Antibiotics for Acute Respiratory Infections
- The Merck Manual for Health Care Professionals: Chronic Obstructive Pulmonary Disease
- Centers for Disease Control and Prevention: Acute Cough Illness (Acute Bronchitis) -- Physician Information Sheet (Adults)
- Clinical Infectious Diseases: Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults