Acute Cough Illness (Acute Bronchitis): Physician Information Sheet (Adults)
Acute bronchitis is an acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks (Chest 2006;129:95S-103S).
Principles apply to the appropriate treatment of cough illness lasting less than 3 weeks in otherwise healthy adults.
Refer to acute cough illness as a “chest cold” to reduce patient expectation for antibiotics (Am J Med 2000;108-83).
- Greater than 90% of cases of acute cough illness are non-bacterial.
- Viral etiologies include influenza, parainfluenza, RSV, and adenovirus.
- Bacterial agents include Bordatella pertussis, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
- The presence of purulent sputum is not predictive of bacterial infection.
- 95% of patients with purulent sputum do not have pneumonia (J Chron Di 1984; 37:215).
- Evaluation should focus on excluding severe illness, particularly pneumonia.
Clinical Assessment for Pneumonia
- Pneumonia is unlikely if all of the following findings are absent (JAMA 1997;278:1440).
Sign Abnormal Finding Fever ≥38°C Tachypnea ≥24 breaths/min Tachycardia ≥100 beats/min Evidence of consolidation
on chest exam
rales, egophony, fremitus
- Consider chest radiograph for patients with any of these findings or cough lasting >3 weeks.
- Empiric antibiotic treatment is not indicated for acute bronchitis.
- Meta-analyses of randomized, controlledtrials all concluded that routine antibiotic treatment is not justified (BMJ 1998;316:906; Chest 2006;129:95S-103S).
- If influenza therapy is considered, it should be initiated within 48 hours of symptom onset for clinical benefit.
- During the 2005-06 Flu recommends that neither amantadine nor rimantadine be used for treatment or prevention of influenza A infections because of high levels of resistance (MMWR 2006 Jan 20;55(2):44-6).
- Neuramidase inhibitors such as oseltamivir or zanamivir have activity against influenza A and B viruses.
- Antiviral therapy reduces symptom duration by approximately 1 day.
- If pertussis is suspected, empiric therapy may be initiated while obtaining a diagnostic test for confirmation.
- Antibiotic treatment decreases transmission but has little effect on symptom resolution.
- Over-the-counter cough suppressants have limited efficacy in relief of cough due to acute bronchitis (Chest 2006; 129:95S-103S).
Tips to Reduce Antibiotic Use
- Tell patients that antibiotic use increases the risk of an antibiotic resistant infection.
- Identify and validate patient concerns.
- Recommend specific symptomatic therapy.
- Spend time answering questions and offer a contingency plan if symptoms worsen.
- Provide patient education materials on antibiotic resistance.
- REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction.
- See www.cdc.gov/drugresistance/community or contact your local health department for more information and patient education materials.
Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17.
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