Antibiotics aren't always the answer. Harris AM, et al. Appropriate antibiotic use for acute respiratory tract infection in adults: Advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Annals of Internal Medicine.
Jong EC, et al. Travel with chronic medical conditions. In: Travel and Tropical Medicine Manual. Fishwick D, et al. Occupational chronic obstructive pulmonary disease: A standard of care.
Occupational Medicine. Use and care of home humidifiers. Environmental Protection Agency. Related Acute bronchitis: Is it contagious? Associated Procedures Chest X-rays. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Because of the clinical uncertainty that may arise in distinguishing acute bronchitis from pneumonia, there is evidence to support the use of serologic markers to help guide antibiotic use.
Two trials in the emergency department setting showed that treatment decisions guided by procalcitonin levels helped decrease the use of antibiotics 83 versus 44 percent in one study, and 85 versus 99 percent in the other study with no difference in clinical outcomes. Because antibiotics are not recommended for routine treatment of bronchitis, physicians are challenged with providing symptom control as the viral syndrome progresses.
Common therapies include antitussives, expectorants, inhaler medications, and alternative therapies. Several small trials and Cochrane reviews help guide therapy for symptom control. The ACCP guidelines suggest that a trial of an antitussive medication such as codeine, dextromethorphan, or hydrocodone may be reasonable despite the lack of consistent evidence for their use, given their benefit in patients with chronic bronchitis. Use of adult preparations in children and dosing without appropriate measuring devices are two common sources of risk to young children.
Although they are commonly used and suggested by physicians, expectorants and inhaler medications are not recommended for routine use in patients with bronchitis. Many patients also use nonprescription, alternative medications for relief of their bronchitis symptoms.
Studies have assessed the benefits of echinacea, pelargonium, and honey. Trials of echinacea in patients with bronchitis and the common cold have yielded inconsistent results, although studies showing positive results have been modest at best. One recent trial examined the effectiveness of dark honey for symptom relief in children with bronchitis compared with dextromethorphan or placebo.
Although the authors concluded that symptom scores from patients treated with dark honey were superior to those treated with placebo, the clinical benefit was small. Many patients with bronchitis expect medications for symptom relief, and physicians are faced with the difficult task of convincing patients that most medications are ineffective against acute bronchitis.
Table 3 includes methods that may facilitate these discussions. Careful word selection and communication skills can help reduce antibiotic prescribing. Explain that antibiotics do not significantly reduce the duration of symptoms, and that they may cause adverse effects and lead to antibiotic resistance.
Explain that many patients would need to be treated with antibiotics to prevent one case of pneumonia. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. ROSS H. At the time this article was written, he was a hospitalist at Grand View Hospital in Sellersville, Pa. Address correspondence to Ross H. Reprints are not available from the author.
The author thanks Elizabeth V. Albert, MD, for her assistance in the preparation of the manuscript. Ambulatory care visits to physicians offices, hospital outpatient departments, and emergency departments: United States, — Vital Health Stat Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial.
Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. Clinical practice. Acute bronchitis. N Engl J Med. Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine. Respir Med. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background.
Ann Intern Med. Public beliefs and use of antibiotics for acute respiratory illness. Ask your doctor or pharmacist about over-the-counter medicines that can help you feel better. Always use over-the-counter medicines as directed. Remember, over-the-counter medicines may provide temporary relief of symptoms, but they will not cure your illness.
Be careful about giving over-the-counter medicines to children. Not all over-the-counter medicines are recommended for children of certain ages. You can help prevent acute bronchitis by doing your best to stay healthy and keep others healthy, including:. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Antibiotic Prescribing and Use. Section Navigation.
Facebook Twitter LinkedIn Syndicate. Chest Cold Acute Bronchitis. Related Topics Colds, cough and flu Lung conditions Prescription drug safety. Placebo A harmless, inactive, and simulated treatment. Randomized controlled trials Studies where people are assigned to one of the treatments purely by chance.
Systematic review A comprehensive evaluation of the available research evidence on a particular topic. Related Evidence Summaries Echinacea may help to slightly reduce the risk of getting an upper respiratory tract infection, but does not decrease length of illness. Related Web Resources Can oseltamivir Tamiflu prevent complications?
Oseltamivir known as Tamiflu is a drug that is meant to prevent complications like pneumonia when you have the flu. Research shows that Tamiflu makes flu symptoms go away sooner, but has side effects like headaches and nausea. Help protect yourself from the flu by washing your hands regularly. This patient decision aid helps people diagnosed with chronic sinusitis decide on whether or not to have surgery by comparing the benefits, risks, and side effects of both options.
It offers alternative methods to surgery such as taking medicine and using home treatment.
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