Bronchitis Organism-Specific Therapy 

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Organism-specific therapeutic regimens for bronchitis are provided below . ^{[1, 2, 3, 4, 5, 6, 7, 8]}

See Bronchitis for full information.

Most acute bronchitis cases in healthy individuals do not have an identifiable cause; therefore, viral etiology is presumed. Nonetheless, some studies implicate bacterial pathogens in up to 25% of cases. ^[7]

Viral

Influenza virus (especially if associated with fevers, chills, headache, cough, and myalgias)

Oseltamivir 75 mg PO BID for 5 days or

Zanamivir 2 puffs (10 mg) inhaled BID for 5 days

Supportive measures for other viruses (eg, Parainfluenzavirus, respiratory syncytial virus, Coronavirus, Adenovirus, & Rhinovirus)

Bordetella pertussis (incubation period of 1-3 weeks, fever is uncommon, suspect if cough persists for >2 weeks): ^[6]

First-line treatment is macrolides:

Azithromycin 500 mg PO on day 1, then 250 mg PO q24h on days 2-5 or

Erythromycin 500 mg PO QID for 14 days or

Clarithromycin 500 mg PO BID for 7 days

Second-line treatment:

Trimethoprim-sulfamethoxazole (160 mg/800 mg) PO BID for 14 days

Mycoplasma pneumoniae (incubation period 2-3 weeks, gradual onset 2-3 days, occurs in clusters such as military or students): ^[6]

Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or

Doxycycline 100 mg PO BID for 5 days or

Consider quinolones if local resistance to macrolides ^[10]

Chlamydophila pneumoniae (incubation period of 3 weeks, gradual onset of hoarseness before cough, occurs in clusters such as military, students, or nursing homes): ^[6]

Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or

Doxycycline 100 mg PO BID for 5 days or

Supportive measures only

Other organisms identified to cause acute bronchitis include: Streptococcus pneumoniae, Haemophilusinfluenzae, and Moraxella catarrhalis. Treatment is below.

Always assess for regional resistance prior to choosing antimicrobial treatment.

Haemophilus influenzae & Haemophilus parainfluenzae: ^[8]

Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or

Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or

Cefuroxime 250-500mg PO BID for 10 days or

Levofloxacin 500 mg PO q24h for at least 7 days or

Moxifloxacin 400 mg PO q24h for 5 days or

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days

Streptococcus pneumoniae: ^[8]

Amoxicillin 500 mg PO TID for 7-14 days or

Amoxicillin/clavulanate 875/125mg PO BID for 7-10 days or

Levofloxacin 500 mg PO q24h for at least 7 days or

Moxifloxacin 400 mg PO q24h for 5 days

Consider macrolides if local resistance is low.

Moraxella catarrhalis: ^[8]

Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or

Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or

Erythromycin 400 mg PO QID for 10 days or

Clarithromycin 250-500 mg PO BID for 7-14 days or

Cefuroxime 250-500 mg PO BID for 10 days or

Levofloxacin 500 mg PO q24h for at least 7 days or

Moxifloxacin 400 mg PO q24h for 5 days or

Ciprofloxacin 500 mg PO for 10 days or

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days

Mycoplasma pneumoniae and Chlamydophila pneumoniae ^[6]

Macrolides and tetracyclines are drugs of choice:

Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or

Erythromycin 400 mg PO QID for 10 days or

Clarithromycin 250-500 mg PO BID for 7-14 days or

Doxycycline 100 mg PO BID for 5 days or

Less active are fluoroquinolones:

Levofloxacin 500 mg PO q24h for at least 7 days or

Moxifloxacin 400 mg PO q24h for 5 days

Staphylococcus aureus ^[8]

For Methicillin-sensitive S aureus (MSSA):

Amoxicillin/clavulanate 875/125mg PO BID for 7-10 days or

Dicloxacillin 125-500 mg PO q6h taken on empty stomach or

Cephalexin 250 mg PO q6h

IV formulated antibiotics include: oxacillin, nafcillin, cefuroxime, and cefazolin

For methicillin-resistant S aureus (MRSA):

Clindamycin 600 mg PO TID for 14 days or

Linezolid 600 mg PO BID for 14 days or

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 14 days

IV formulated antibiotics include: vancomycin and daptomycin

Klebsiella pneumoniae ^[8]

Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or

Cefuroxime 250-500 mg PO BID for 10 days or

Levofloxacin 500 mg PO q24h for at least 7 days or

Moxifloxacin 400 mg PO q24h for 5 days or

Ciprofloxacin 500 mg PO for 10 days or

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days

IV formulated antibiotics include: ceftriaxone, gentamicin, amikacin, aztreonam, piperacillin/tazobactam, and imipenem/cilastatin.

Pseudomonas aeruginosa ^[8]

Levofloxacin 500 mg PO q24h for at least 14 days 

Ciprofloxacin 500 mg PO for 14 days or

Consider IV formulations and double antimicrobial coverage if severely ill:

Piperacillin/tazobactam or ticarcillin/clavulanate

Cefepime or ceftazidime

Meropenem or imipenem/cilastatin

Tobramycin or gentamicin

Aztreonam

See the list below:

Patients should receive the influenza vaccine yearly between October and December.

Patients aged 65 years or older or with chronic disease should receive pneumococcal vaccines; prevnar 13 and pneumovax 23, when possible prevnar 13 should be given first ^[9] . 

Knutson D, Braun C. Diagnosis and management of acute bronchitis. Am Fam Physician. May 15 2002. 65(10):2039-44.

Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med. Nov 16 2006. 355(20):2125-30.

Smucny J, Becker L, Glazier R. Beta2-agonists for acute bronchitis. Cochrane Database Syst Rev. Oct 18 2006. CD001726.

Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008. 337:a437.

Siempos II, Dimopoulos G, Korbila IP, Manta K, Falagas ME. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J. Jun 2007. 29(6):1127-37.

Wenzel RP, Fowler AA 3rd. Clinical practice: Acute bronchitis. New England Journal of Medicine. November 2006. 355(20):2125-30.

Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Systemic Review. March 2014. 3:1-43.

Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. European Respiratory Journal. June 2012. 39(6):1354-60.

Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014. 63:82.

AU Zhao F, Lv M, Tao X, Huang H, Zhang B, Zhang Z, et al. Antibiotic sensitivity of 40 Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant isolates. Antimicrob Agents Chemother. 2012 Feb. 56(2:1108-9.

Jazeela Fayyaz, DO Pulmonologist, Department of Pulmonology, Unity Hospital

Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Ravikanth Vydyula, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Ravikanth Vydyula, MD is a member of the following medical societies: American College of Physicians, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Maciej P Walczyszyn, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Hospitalist, Alliance Medical Group, Inc, Waterbury Hospital

Maciej P Walczyszyn, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John J Oppenheimer, MD Clinical Professor, Department of Medicine, Rutgers New Jersey Medical School; Director of Clinical Research, Pulmonary and Allergy Associates, PA

John J Oppenheimer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, New Jersey Allergy, Asthma and Immunology society

Disclosure: Received research grant from: quintiles, PRA, ICON, Novartis: Adjudication<br/>Received consulting fee from AZ for consulting; Received consulting fee from Glaxo, Myelin, Meda for consulting; Received grant/research funds from Glaxo for independent contractor; Received consulting fee from Merck for consulting; Received honoraria from Annals of Allergy Asthma Immunology for none; Partner received honoraria from ABAI for none. for: Atlantic Health System.

Bronchitis Organism-Specific Therapy 

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