treatment

Last reviewed 01/2018

It is probably inadvisable to use cough suppressants.

• there is evidence that antibiotics have a slight beneficial benefit in the treatment of uncomplicated acute bronchitis
• a review by Bent and colleagues examined randomised controlled trials that compared antibiotics with placebo in patients with acute bronchitis but had no history of pneumonia or chronc lung disease. The review showed that use of antibiotics reduces cough and sputum production by about half a day (1)
  
  
• Public Health England suggest (2):
  • antibiotic little benefit if no co-morbidity
  • consider 7d delayed antibiotic with advice
  • symptom resolution can take 3 weeks
  • consider immediate antibiotics if > 80yr and ONE of:
    • hospitalisation in past year, oral steroids, diabetic, congestive heart failure
    • OR > 65yrs with 2 of above
      
      
• if antibiotic treatment is initiated
  • on the limited occasions when an antibiotic is indicated, a five-day course of amoxicillin (500mg three times a day), oxytetracycline (250-500mg four times a day) or doxycycline (200mg on the first day, then 100mg daily) is a suitable first choice (doses quoted are for adults) (2,3)

Notes:

• little evidence to support the use of oral or inhaled beta 2-agonists (e.g. salbutamol) in adults or children with acute cough or bronchitis and no underlying pulmonary disease (2)
  • a Cochrane review found that patients given b2-agonists were more likely to report tremor, shakiness, or nervousness than patients in the control group (3)
• analgesics and antipyretics may be used where appropriate
• insufficient evidence to support the use of other over-the-counter cough medicines
• simplest and cheapest treatment for a cough may be a home remedy such as honey and lemon

Reference:

1. Bent S et al (1999). Antibiotics in acute bronchitis: a meta-analysis. Am J Med.;107(1):62-7
2. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
3. MeReC Bulletin 2006;17(3):12-14.
4. Smucny J, Flynn C, Becker L, et al. Beta2-agonists for acute bronchitis. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001726