Bronchitis Organism-Specific Therapy

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

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.[6]

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)[2] :

• 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)[2] :

• 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[8]

Chlamydophila pneumoniae (incubation period of 3 weeks, gradual onset of hoarseness before cough, occurs in clusters such as military, students, or nursing homes)[2] :

• 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 and Haemophilus parainfluenzae[7] :

• 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[7] :

• 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[7] :

• 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[2] :

• 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[7] :

• 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[7] :

• 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[7] :

• 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

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 (separated by at least 1 year).[9]