Acute Bronchitis
GENERAL PRINCIPLES
Acute bronchitis involves inflammation of the bronchi, most often caused by viruses such as coronavirus, rhinovirus, influenza, or parainfluenza. Uncommon causes include M.
pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis. Unfortunately, 60%-90% of patients with acute bronchitis are given antibiotics.DIAGNOSIS
Clinical Presentation
Symptoms include cough with or without sputum production lasting >5 days sometimes with associated wheezing or rhonchi on physical examination. Up to half of the patients have purulent sputum production; however, fever is uncommon.
Diagnostic Testing
• Diagnosis is made clinically. Sputum cultures are not recommended.
• COVID-19 should be ruled out.
• In febrile, systemically ill, or older patients with abnormal vital signs, pneumonia should be evaluated for radiographically, and diagnostic tests for influenza should be performed depending on the season and local disease trends.
• Cough lasting >2 weeks in an adult should be evaluated for pertussis with a nasopharyngeal swab for culture or PCR.
TREATMENT
• Treatment is symptomatic and should be directed toward controlling cough (dextromethorphan 15 mg PO q6h).
• Multiple studies have shown no benefit in antimicrobial therapy for generally healthy patients with acute, non-pertussis-related bronchitis.
• Pertussis treatment consists of azithromycin 500 mg PO single dose followed by 250 mg PO qday for 4 more days, or clarithromycin 500 mg PO q12h for 14 days. Cases should be reported to the local health department for contact tracing and administration of postexposure prophylaxis of contacts with azithromycin when indicated.