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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). |
Background |
- 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).
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Diagnosis |
- Evaluation should focus on excluding
severe illness, particularly pneumonia.
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Clinical Assessment for
Pneumonia |
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.
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Treatment |
- 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.
http://www.cdc.gov/flu/ 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).
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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.
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.
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