Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
No Antibiotics for Acute Bronchitis
Acute bronchitis is a cough-related illness of the air passages (bronchi) cough persists for more than five days (it often lasts for 1 to 3 weeks), with or without production of sputum (whitish, yellow or green phlegm, or “secretions”), and sometimes with fever, hoarseness, muscle aches, fatigue, and wheezing. It occurs in persons without chronic lung disease and is accompanied by a normal chest x-ray. Viruses (most commonly) and bacteria may cause acute bronchitis. Pneumonia is much more intense than bronchitis, and involves severe progressive pulmonary deterioration; bronchitis is a less debilitating condition. Cigarette smokers are prone to recurrent bouts of "chronic" bronchitis, because they suffer from scarred lungs and continually paralyze the defense mechanisms of the nose, throat, and lungs with cigarette smoke.
Treatment of acute bronchitis is controversial, particularly with regard to antibiotic administration, since in the absence of a documented infection, no particular therapy has been shown to shorten the duration of bronchitis. David Newman, MD wrote a recent brief piece for Emergency Physicians Monthly (June 2012, page 16), in which he commented on his review of 15 randomized controlled trials of the use of antibiotics for acute bronchitis. His conclusion was that there aren't compelling data to support antibiotic use. He noted that antibiotics did not increase the number of persons who were clinically improved or cured at follow-up and that there was perhaps a one-half day shortening of the course of illness, while there was a slight increase in the number of patients with adverse effects. He concluded that the risks slightly outweighed the benefits. This all seems well thought out and quite reasonable.
When should a person use antibiotics for bronchitis? Until further notice, if signs and symptoms of a worsening bacterial infection (such as production of dark or bloody sputum, accompanied by more difficulty breathing, increasing chest pain, fever and chills, or other signs of pneumonia) become evident and you are remote from the ability to obtain a formal medical evaluation including a chest x-ray, therapy may include administration of an oral antibiotic (first choice azithromycin, levofloxacin, or amoxicillin-clavulanate; others include moxifloxacin, amoxicillin, trimethoprim-sulfamethoxazole, doxycycline, cefixime, cefpodixime, cefproxil, or erythromycin). With or without antibiotics, copious fluid intake, inhalation of humidified warm air (taking care to avoid steam burns) in order to loosen secretions and ease coughing, a drug to loosen secretions (e.g., guaifenesin [Mucinex] 600 mg by mouth every 12 hours), and acetaminophen or aspirin (the latter not for children under age 17 years) for fever may diminish symptoms.
It is best to allow the victim to cough up secretions; however, if coughing fits become intolerable, a cough medicine may be used. Dextromethorphan is more effective than guaifenesin, which does not control cough. If wheezing and shortness of breath are problematic, an inhaled bronchodilator, such as albuterol, may be used.
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