Bronchitis Organism-Specific Therapy 

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)

  • 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.

Acute bacterial exacerbation of chronic bronchitis (ABECB)

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

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] .