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. 1996 Sep;11(9):557–562. doi: 10.1007/BF02599608

Treatment of acute bronchitis in adults without underlying lung disease

Donald N MacKay
PMCID: PMC7088579  PMID: 8905509

Abstract

OBJECTIVE: To determine whether antibiotic and bronchodilator treatment of acute bronchitis in patients without lung disease is efficacious.

DESIGN: A MEDLINE search of the literature from 1966 to 1995 was done, using “Bronchitis” as the key word. Papers addressing acute bronchitis in adults were used as well as several citations emphasizing pediatric infections. A manual search of papers addressing the microorganisms causing acute bronchitis was also done. Data were extracted manually from relevant publications.

SETTING: All published reports were reviewed. Papers dealing with exacerbations of chronic bronchitis were excluded in this review.

RESULTS: Although acute bronchitis has multiple causes, the large majority of cases are of viral etiology.Mycoplasma pneumoniae, Chlamydia pneumoniae, andBordetella pertussis are the only bacteria identified as contributing to the cause of acute bronchitis in otherwise healthy adults. Nine double-blind, placebo-controlled trials were reviewed. Four studies showed no advantage for doxycycline and one study showed no advantage for erythromycin. One study using erythromycin and one study using trimethoprim and sulfamethoxazole showed that these antibiotics were slightly better than placebo. Two other studies showed an impressive superiority for liquid or inhaled albuterol when compared with erythromycin.

CONCLUSIONS: Most studies showed no significant difference between drug and placebo, and the two studies that did showed only small clinical differences. Albuterol had an impressive advantage over erythromycin. Antibiotics should not be used in the treatment of acute bronchitis in healthy persons unless convincing evidence of a bacterial infection is present.

Key words: acute bronchitis, bronchitis, bronchitis treatment

Footnotes

Received from the Division of General Internal Medicine, Stanford University Medical School, 900 Blake Wilbur Dr., Suite W2080, Stanford University, Stanford, CA 94305.

References

  • 1.Moffet HL. Common infections in ambulatory patients. Ann Intern Med. 1978;89(pt 2):743–5. doi: 10.7326/0003-4819-89-5-743. [DOI] [PubMed] [Google Scholar]
  • 2.Marsland DW, Wood M, Mayo F. Content of family practice. J Fam Pract. 1976;3:37–8. [PubMed] [Google Scholar]
  • 3.National Ambulatory Care Survey: 1989 Summary. Vital Health Stat [13]. 110:12–45. [PubMed]
  • 4.Brickfield FX, Carter WH, Johnson RE. Erythromycin in the treatment of acute bronchitis in a community practice. J Fam Pract. 1986;23:119–22. [PubMed] [Google Scholar]
  • 5.Hueston WJ. A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract. 1991;33:476–80. [PubMed] [Google Scholar]
  • 6.Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract. 1994;39:437–40. [PubMed] [Google Scholar]
  • 7.Williamson HA., Jr A randomized, controlled trial of doxycycline in acute bronchitis. J Fam Pract. 1984;19:481–8. [PubMed] [Google Scholar]
  • 8.Scherl ER, Riegler SL, Cooper JK. Doxycycline in acute bronchitis: a randomized double-blind trial. J Ky Med Assoc. Sept 1987;539–41. [PubMed]
  • 9.Baxter PJ, Ing R, Falk H, Plikaytis B. Mount St. Helens eruptions: the acute respiratory effects of volcanic ash in a North American community. Arch Environ Health. 1983;38:138–43. doi: 10.1080/00039896.1983.10543994. [DOI] [PubMed] [Google Scholar]
  • 10.Mogabgab WJ. Mycoplasma pneumoniae and adenovirus respiratory illness in military and university personnel, 1959–1966. Am Rev Respir Dis. 1968;97:345–57. doi: 10.1164/arrd.1968.97.3.345. [DOI] [PubMed] [Google Scholar]
  • 11.Mogabgab WJ. Acute respiratory illness in university (1962–1966), military and industrial (1962–1963) populations. Am Rev Respir Dis. 1968;98:359–77. doi: 10.1164/arrd.1968.98.3.359. [DOI] [PubMed] [Google Scholar]
  • 12.Franson H, Sterner G, Forsgren M, et al. Acute lower respiratory illness in elderly patients with respiratory syncytial virus infection. Acta Med Scand. 1967;182:323–9. doi: 10.1111/j.0954-6820.1967.tb11530.x. [DOI] [PubMed] [Google Scholar]
  • 13.Higgins PG. Viruses associated with acute respiratory infections 1961–71. J Hyg Camb. 1974;72:425–32. doi: 10.1017/s0022172400023664. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Gwaltney JM. Pleuropulmonary and bronchial infections. In: Man-dell GL, Douglas RG, Bennett JE, editors. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY: Churchill Livingstone; 1990. pp. 529–31. [Google Scholar]
  • 15.Sherry MK, Klainer AS, Wolff M, Gerhard H. Herpetic tracheobronchitis. Ann Intern Med. 1988;109:229–33. doi: 10.7326/0003-4819-109-3-229. [DOI] [PubMed] [Google Scholar]
  • 16.Grayston JT, Aldous MB, Easton A, et al. Evidence thatClamydla pneumonia causes pneumonia and bronchitis. J Infect Dis. 1993;168:1231–5. doi: 10.1093/infdis/168.5.1231. [DOI] [PubMed] [Google Scholar]
  • 17.MacLean DW. Adults with pertussis. J R Coll Gen Pract. 1982;32:298–300. [PMC free article] [PubMed] [Google Scholar]
  • 18.A collaborative study of the aetiology of acute respiratory infections in Britain 1961–4. A report of the Medical Research Council Working Party on Acute Respiratory Virus Infections. BMJ. 1965;2:319–26. [DOI] [PMC free article] [PubMed]
  • 19.Hall WJ, Hall CB, Speers DM. Respiratory syncytial virus infection in adults: clinical, virologic, and serial pulmonary function studies. Ann Intern Med. 1978;88:203–5. doi: 10.7326/0003-4819-88-2-203. [DOI] [PubMed] [Google Scholar]
  • 20.Foy HM. Infections caused byMycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis. 1993;17(suppl 1):37S–46S. doi: 10.1093/clinids/17.supplement_1.s37. [DOI] [PubMed] [Google Scholar]
  • 21.Grayston JT. Infections caused byChlamydia pneumoniae strain TWAR. Clin Infect Dis. 1992;15:757–63. doi: 10.1093/clind/15.5.757. [DOI] [PubMed] [Google Scholar]
  • 22.Foy HM, Grayston JT, Kenny GE, Alexander ER, McMahan R. Epidemiology ofMycoplasma pneumonia infection in families. JAMA. 1966;197:137–44. doi: 10.1001/jama.197.11.859. [DOI] [PubMed] [Google Scholar]
  • 23.Lapin JH. Whooping Cough. Springfield, Ill: Charles C. Thomas; 1943. pp. 112–22. [Google Scholar]
  • 24.Biellik RJ, Patriarca PA, Mullen JR, et al. Risk factors for community- and household-acquired pertussis during a large-scale outbreak in central Wisconsin. J Infect Dis. 1988;157:1134–41. doi: 10.1093/infdis/157.6.1134. [DOI] [PubMed] [Google Scholar]
  • 25.MMWR. Dec 17, 1993;952-60.
  • 26.Lambert HJ. Epidemiology of a small pertussis outbreak in Kent County, Michigan. Public Health Rep. 1965;80:365–9. [PMC free article] [PubMed] [Google Scholar]
  • 27.Bergquist S, Sverker B, Dahnsjo H, Sundelof B. Erythromycin in the treatment of pertussis: a study of bacteriologic and clinical effects. Pediatr Infect Dis J. 1987;6:458–61. doi: 10.1097/00006454-198705000-00009. [DOI] [PubMed] [Google Scholar]
  • 28.Chodosh S. Acute bacterial exacerbations in bronchitis and asthma. Am J Med. 1987;82(suppl 4A):154–63. [PubMed] [Google Scholar]
  • 29.Beasley R, Coleman ED, Hermon Y, Hoist PE, O’Donnell TV, Tobias M. Viral respiratory tract infection and exacerbations of asthma in adult patients. Thorax. 1988;43:679–83. doi: 10.1136/thx.43.9.679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Williamson HA, Schultz P. An association between acute bronchitis and asthma. J Fam Pract. 1987;24:35–8. [PubMed] [Google Scholar]
  • 31.O’Connor SA, Jones DP, Collins JV, Heath RB, Campbell MJ, Leighton MH. Changes in pulmonary function after naturally acquired respiratory infection in normal persons. Am Rev Respir Dis. 1979;120:1087–93. doi: 10.1164/arrd.1979.120.5.1087. [DOI] [PubMed] [Google Scholar]
  • 32.Clyde WA., Jr Clinical overview of typicalMycoplasma pneumoniae infections. Clin Infect Dis. 1993;17(Suppl 1):32S–6S. [PubMed] [Google Scholar]
  • 33.Hahn DL, Dodge RW, Golubjatnikov R. Association ofChlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma. JAMA. 1991;266:225–30. doi: 10.1001/jama.266.2.225. [DOI] [PubMed] [Google Scholar]
  • 34.Murray HW, Masur H, Senterfit LB, Roberts RB. The protean manifestations ofMycoplasma pneumoniae infection in adults. Am J Med. 1975;58:229–42. doi: 10.1016/0002-9343(75)90574-4. [DOI] [PubMed] [Google Scholar]
  • 35.Grayston JT, Campbell LA, Kuo CC, et al. A new respiratory tract pathogen:Chylamydia pneumonia strain TWAR. J Infect Dis. 1990;161:618–25. doi: 10.1093/infdis/161.4.618. [DOI] [PubMed] [Google Scholar]
  • 36.Griffen JP, Klien EW. Role of sinusitis in primary atypical pneumonia. Clin Med, April 1971;23-7.
  • 37.Gleckman RA. Bronchial infections: acute bronchitis and acute exacerbations of chronic bronchitis. Compr Ther. 1987;13(2):44–8. [PubMed] [Google Scholar]
  • 38.Rodnick JE, Gude JK. The use of antibiotics in acute bronchitis and acute exacerbations of chronic bronchitis. West J Med. 1988;149:347–51. [PMC free article] [PubMed] [Google Scholar]
  • 39.Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet. 1995;345:665–6. doi: 10.1016/S0140-6736(95)90861-7. [DOI] [PubMed] [Google Scholar]
  • 40.Hayden FG, Monto AS. Oral rimantadine hydrochloride therapy of influenza A virus H3N2 subtype infection in adults. Antimicrob Agents Chemother. 1986;29:339–41. doi: 10.1128/aac.29.2.339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Younkin SW, Betts RF, Roth FA, Douglas RG., Jr Reduction in fever and symptoms in young adults with influenza A/Brazil/78 H1N1 infection after treatment with aspirin or amantidine. Antimicrob Agents Chemother. 1983;23:577–82. doi: 10.1128/aac.23.4.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Wingfield WL, Pollack MD, Grunert RR. Therapeutic efficacy of amantadine HC1 and rimantadine HC1 in naturally occurring influenza A2 respiratory illness in man. N Engl J Med. 1969;281:579–84. doi: 10.1056/NEJM196909112811102. [DOI] [PubMed] [Google Scholar]
  • 43.Hall CB, Walsh EE, Hruska JF, Betts RF, Hall WJ. Ribavirin treatment of experimental respiratory syncytial viral infection. JAMA. 1983;249:2666–70. doi: 10.1001/jama.249.19.2666. [DOI] [PubMed] [Google Scholar]
  • 44.Stott NCH, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. BMJ. 1976;2:556–9. doi: 10.1136/bmj.2.6035.556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Verheij TJM, Hermans J, Mulder JD. Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial. Br J Gen Pract. 1994;44:400–4. [PMC free article] [PubMed] [Google Scholar]
  • 46.Franks P, Gleiner JA. The treatment of actue bronchitis with trimethoprim and sulfamethoxazole. J Fam Pract. 1984;19:185–90. [PubMed] [Google Scholar]
  • 47.Dunlay J, Reinhardt R, Roi LD. A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis. J Fam Pract. 1987;25:137–41. [PubMed] [Google Scholar]
  • 48.Murray ME. New aspects of antimicrobial resistance and the resulting therapeutic dilemmas. J Infect Dis. 1991;163:1185–94. [PubMed] [Google Scholar]

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