Introduction
Acute Bronchitis is an inflammation of the bronchial tubes commonly caused by a variety of viruses, same as those that are responsible for common cold.
Primary bacterial aetiology may also occur.
Acute bronchitis can last from a few days to 10 days but the associated cough may last for several weeks after the infection has cleared up.
Bronchitis lasting up to 90days is still usually classified as acute bronchitis.
Symptoms and clinical features of acute bronchitis
- Cough
- Sputum production
- Sputum may be clear, yellow or greenish
- Wheezing
- Muscle and backache
- Low grade fever
- Shortness of breath in severe cases
- Chest pain especially while coughing
Differential diagnosis
- Cough-variant asthma
- Mycoplasma pneumonia
- Chlamydia pneumonia
- Bordetella pertussis
Complications of acute bronchitis
- Pneumonia
- Acute respiratory failure
- Repeated bouts of acute bronchitis over time may lead to COPD
Relevant investigations
- Chest x-ray
- Sputum tests
- (Quality sputum for culture and tests for evidence of allergy)
- Pulmonary function tests
Management
Antibiotics usually is not required in the treatment of acute bronchitis unless
there is clear evidence of primary
bacterial aetiology or secondary bacterial infection
Drug treatment
Empirical antimicrobials
Examples:
Amoxicillin
Adult:
- 500mg PO 8 hourly for 5-7 days
Child:
- <3 months: 30 mg/kg/day PO divided q12hr
- >3 months and <40 kg: 25 mg/kg/day PO divided q12hr or 20 mg/kg/day PO divided q8h
- 40 kg: 500 mg PO q12hr or 250 mg PO q8hr
Macrolide e.g. Erythromycin Stearate
Adult:
- 500mg 8 hourly 5-7 days
Child:
- 30-50 mg/kg/day PO divided q6-8hr
Co-trimoxazole
Adult:
- 960mg 12hourly 5 – 7 days
Child:
- < 2 months: contraindicated
- > 2 months: 8 mg TMP/kg/day PO divided q12hr
Adverse events related to drugs
- Nausea
- Skin rashes,
- rarely Stevens Johnson syndrome with co-trimoxazole.