Bronchitis Organism-Specific Therapy 

Updated: Jan 09, 2017
  • Author: Jazeela Fayyaz, DO; Chief Editor: John J Oppenheimer, MD  more...
  • Print

Specific Organisms and Therapeutic Regimens

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

See Bronchitis for full information.

Acute bronchitis

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)
  • 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:

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.

Acute bacterial exacerbation of chronic bronchitis (ABECB)

Always assess for regional resistance prior to choosing antimicrobial treatment.

Haemophilus influenzae & Haemophilus parainfluenzae: [8]

Streptococcus pneumoniae: [8]

Moraxella catarrhalis: [8]

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:

Staphylococcus aureus [8]

Klebsiella pneumoniae [8]

Pseudomonas aeruginosa [8]

Adjunctive therapy

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]