Bronchitis Organism-Specific Therapy 

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

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)

    • 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] . 

 

Questions & Answers

Overview

What causes acute bronchitis?

What are the organism-specific therapeutic regimens for viral bronchitis?

What are the organism-specific therapeutic regimens for Bordetella pertussis bronchitis?

What are the organism-specific therapeutic regimens for Mycoplasma pneumoniae bronchitis?

What are the organism-specific therapeutic regimens for Chlamydophila pneumoniae bronchitis?

What should be assessed prior to administering antimicrobial treatment for acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Haemophilus influenzae and Haemophilus parainfluenzae acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Moraxella catarrhalis acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Streptococcus pneumoniae acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Mycoplasma pneumoniae and Chlamydophila pneumoniae acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Staphylococcus aureus acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Klebsiella pneumoniae acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the organism-specific therapeutic regimens for Pseudomonas aeruginosa acute bacterial exacerbation of chronic bronchitis (ABECB)?

What are the adjunctive therapies used in the treatment of bronchitis?