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
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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
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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]
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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
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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]
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Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or
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Doxycycline 100 mg PO BID for 5 days or
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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]
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Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 or
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Doxycycline 100 mg PO BID for 5 days or
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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]
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Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
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Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or
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Cefuroxime 250-500mg PO BID for 10 days or
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Levofloxacin 500 mg PO q24h for at least 7 days or
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Moxifloxacin 400 mg PO q24h for 5 days or
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
Streptococcus pneumoniae: [8]
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Amoxicillin 500 mg PO TID for 7-14 days or
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Amoxicillin/clavulanate 875/125mg PO BID for 7-10 days or
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Levofloxacin 500 mg PO q24h for at least 7 days or
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Moxifloxacin 400 mg PO q24h for 5 days
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Consider macrolides if local resistance is low.
Moraxella catarrhalis: [8]
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Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
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Azithromycin 500 mg PO on day 1 then 250 mg on days 2-5 alternatively 500 mg PO daily for 3 days or
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Erythromycin 400 mg PO QID for 10 days or
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Clarithromycin 250-500 mg PO BID for 7-14 days or
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Cefuroxime 250-500 mg PO BID for 10 days or
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Levofloxacin 500 mg PO q24h for at least 7 days or
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Moxifloxacin 400 mg PO q24h for 5 days or
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Ciprofloxacin 500 mg PO for 10 days or
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
Mycoplasma pneumoniae and Chlamydophila pneumoniae [6]
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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
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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]
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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
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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]
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Amoxicillin/clavulanate 875/125 mg PO BID for 7-10 days or
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Cefuroxime 250-500 mg PO BID for 10 days or
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Levofloxacin 500 mg PO q24h for at least 7 days or
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Moxifloxacin 400 mg PO q24h for 5 days or
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Ciprofloxacin 500 mg PO for 10 days or
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h for 10-14 days
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IV formulated antibiotics include: ceftriaxone, gentamicin, amikacin, aztreonam, piperacillin/tazobactam, and imipenem/cilastatin.
Pseudomonas aeruginosa [8]
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Levofloxacin 500 mg PO q24h for at least 14 days
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Ciprofloxacin 500 mg PO for 14 days or
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Consider IV formulations and double antimicrobial coverage if severely ill:
Adjunctive therapy
See the list below:
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Patients should receive the influenza vaccine yearly between October and December.
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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] .