Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults

Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults

Vincenza Snow, MD;
Christel Mottur-Pilson, PhD;
Ralph Gonzales, MD, MSPH; and
for the American College of Physicians–American Society of Internal Medicine*

CLINICAL PRACTICE GUIDELINE, PART 1

In this guideline, evidence is presented and specific recommendations are made about how clinicians can differentiate between bacterial and viral causes of acute bronchitis and about when the use of antibiotics in acute bronchitis is beneficial. The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, “Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults: Background,” which is part 2 of this guideline (see pages 521-529).

Acute Bronchitis

Acute bronchitis is a clinical diagnosis, usually referring to an acute respiratory tract infection in which cough, with or without phlegm, is a predominant feature. The American College of Chest Physicians defines acute cough illness, in contrast to chronic or persistent cough, as lasting less than 3 weeks. As one might expect, there is frequent overlap in how clinicians assign each diagnosis. For example, some clinicians diagnose acute bronchitis only when productive cough is present; others insist on the presence of purulent sputum [1.1].

Acute upper respiratory tract infection accounted for approximately 70% of primary diagnoses in adults presenting for an ambulatory office visit with a chief symptom of cough. Asthma and pneumonia were the next most common diagnoses, assigned to 6% and 5% of patients, respectively. Previously undiagnosed asthma is a consideration in patients presenting with an acute cough illness. However, in the setting of acute cough (<2 to 3 weeks' duration), the diagnosis of asthma is difficult to establish because of transient bronchial hyperresponsiveness (and abnormal results on spirometry), which many patients with uncomplicated acute bronchitis will have. Since pneumonia is the third most common cause of acute cough illness and potentially the most serious, the primary diagnostic objective should be to exclude the presence of pneumonia [1.1–1.3].