Acute Cough Illness (Acute Bronchitis) 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). Pi i l l h i f h ill l i l h 3 k i h i h lh Background Treatment TIPS TO REDUCE ■ Greater than 90% of cases of acute cough ■ Empiric antibiotic treatment is not ANTIBIOTIC USE illness are non-bacterial. indicated for acute bronchitis. ■ Tell patients that anti- - Viral etiologies include influenza, - Meta-analyses of randomized, biotic use increases the parainfluenza, RSV, and adenovirus. controlled trials all concluded that risk of an antibiotic- - Bacterial agents include Bordatella routine antibiotic treatment is not resistant infection. pertussis, Mycoplasma pneumoniae, justified (BMJ 1998;316:906; Chest and Chlamydophila pneumoniae. 2006;129:95S-103S). ■ Identify and validate patient concerns. ■ The presence of purulent sputum is not ■ If influenza therapy is considered, it predictive of bacterial infection. should be initiated within 48 hours of ■ Recommend specific - >95% of patients with purulent sputum do symptom onset for clinical benefit. symptomatic therapy. not have pneumonia (J Chron Di 1984; - During the 2005-06 Flu season CDC 37:215). recommends that neither amantadine nor ■ Spend time answering rimantadine be used for treatment or questions and offer a Diagnosis prevention of influenza A infections contingency plan if because of high levels of resistance symptoms worsen. ■ Evaluation should focus on excluding (MMWR 2006 Jan 20;55(2):44-6). severe illness, particularly pneumonia. ■ Provide patient education - Neuramidase inhibitors such as oseltamivir materials on antibiotic or zanamivir have activity against influenza Clinical Assessment for A and B viruses. resistance. Pneumonia - Antiviral therapy reduces symptom duration ■ REMEMBER: Effective by approximately 1 day. communication is more ■ Pneumonia is unlikely if all of the http://www.cdc.gov/flu/professionals/treatment/ following findings are absent (JAMA important than an 1997;278:1440). ■ If pertussis is suspected, empiric therapy antibiotic for patient may be initiated while obtaining a satisfaction. Sign Abnormal diagnostic test for confirmation. Finding ■ See www.cdc.gov/ - Antibiotic treatment decreases transmission getsmart or contact your Fever ≥ 38 C but has little effect on symptom resolution. local health department Tachypnea ≥ 24 breaths/min ■ Over-the-counter cough suppressants for more information and Tachycardia ≥ 100 beats/min have limited efficacy in relief of cough patient education due to acute bronchitis (Chest 2006; materials. Evidence of rales, egophony, 129:95S-103S). consolidation fremitus on chest exam Key Reference ■ Consider chest radiograph for patients Gozales R et al. Principles of appropriate antibiotic use for with any of these findings or cough treatment of uncomplicated acute lasting >3 weeks. bronchitis: Background. Annals of Internal Medicine 2001; 134(6):521-90.