TOC | Pulm | ID    

                       

Acute Bronchitis                                                                                  See also   COPD | Asthma | Pertussis   
Best Therapy                                     REF:  Best Dx/ Best Rx 2006       See Bronchitis.pdf 2006
  • Antibiotics generally not indicated
  • Oseltamivir/Tamiflu 75 mg bid x 5days PO  treatment of acute influenza reduces frequency of acute bronchitis.  
  • Cough suppressant with codeine or dextromethorphan may be helpful in protracted cough
    (use with caution in patients with underlying chronic obstructive disease)
  • Inhaled beta agonist bronchodilators (e.g., albuterol) may decrease duration of cough   

   
Acute Bacterial Bronchitis Rx
  • Amoxicillin 500mg tid
    -All S.pneumoniae, many H.influenzae that do not produce B-lactamase. 
  • Augmentin (Amoxacillin/clavulanate) 500mg tid
    -All S.pneumoniae, H.influenza, Moraxella catarrhalis.
  • Erythromycin 500mg or EES 400mg qid
    -S.pneumoniae, M.catarrhalis, Mycoplasma, Chlamydia pneumoniae, Legionella sp. 
  • Azithromycin  (Zithromax) 250 mg 2 tab, then 1/day for total of 5 days
    -Chlamydia trachomatis, H.influenzae, Legionella sp., Moraxella catarrhalis, Mycoplasma pneumoniae,  S.aureus, Streptococcus pygenes
    -Campylobacter jejuni, Chlamydophilia pneumoniae, Hemohilus ducreyi (chancroid), Salmonella typhi, Shigella sp.
  • Clarithromycin (Biaxin) 500 mg bid x 1 week.                  
  • Cefaclor/Ceclor 500mg tid
    -S.pneumoniae 
  • Cefixime/Suprax 400mg qd
    -H.influenza                                     
  • Cefuroxime/Ceftin 500mg bid
    -M.catarrhalis
  • Ciprofloxacin/Cipro 500mg bid
    -H.influenza, M.catarrhalis, S.pneumo.
  • Doxycycline/Vibramycin 100mg bid
    -All except a small number of S.pneumo & H.influenza.
    -Moraxella caratthalis, Mycoplasma pneumonaie, Ricketssiae sp., Streptococcus anerobic, Vibrio cholerae,  Campylobacter jejuni, Chlamydophilia pneumoniae, Chlamydia trachomatis, Clostridium perfringens, Clostridium tetani, Tetanus, Q-fever, Tularemia.
  • Septra (Sulfamethoxazole/trimethoprim) DS bid
    -95% of S.pneumo, H.influenza, M.catarrhalis.

   
Diff-Dx of Acute Exacerbation of Chronic Bronchitis (AECB)
  • Bacterial bronchitis:
    - Common organisms: Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis.
    _ Less common organisms: gram-negative bacteria as Pseudomonas aeruginosa; Staphlococcus aureus, Mycoplasma pneumoniae, Chlamydia pneumoniae
  • Viral bronchitis
  • Community-acquired pneumonia
  • Allergic or chemical tracheobronchitis
  • Congestive heart failure
  • Bronchospasm, including that induced by GE reflux
  • Pulmonary embolus
  • Pneumothorax

   
Antibiotic Rx Options for Acute Exacerbation of Chronic Bronchitis (AECB)
  1. Azithromycin or clarithromycin, new cephalosporins (cefpodoxime, defuroxime, cefprozil), doxycycline
    -for simple AECB (any age, <4x/yr, no comorbid illness)
    -likely pathogens: core organisms & H.parainfluenzae.
  2. Fluoroquinolones as Cipro, or amoxicillin+clavulanate (Augmentin)
    -for complicated AECB (age>65, >4x/yr, + comorbid illness)
    -likely pathogens: core organisms, but often drug-resistant pneumococci or B-lactamase-producing H.influenzae or M. catarrhalis; also some risk for enteric G-negative bacteria.
  3. Quinolone with antipseudomonal activity (Ciprofloxacin)
    -for complicated AECB at risk for Pseudomonas aeruginosa

   

                                                                                                   

      

2006