Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Acute Cough Illness (Acute Bronchitis): Physician Information Sheet (Adults)

Print-friendly version of this academic detailing sheet [134 KB, 1 page]

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.

Top of Page


  • 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. professionals/treatment/
  • 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 or contact your local health department for more information and patient education materials.

Key Reference

Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17.

Top of Page

Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more

External Web Site Policy This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.

Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    TTY: (888) 232-6348
    Contact CDC-INFO The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #