Acute bronchitis: Difference between revisions
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**Do not treat patients with antibiotics unless:<ref>Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337</ref> | **Do not treat patients with antibiotics unless:<ref>Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337</ref> | ||
***older than 65 years | ***older than 65 years | ||
*** | ***Recent hospitalizations in the past year | ||
***Diabetes | ***Diabetes | ||
***On chronic steroids | ***On chronic steroids | ||
Revision as of 03:34, 23 February 2014
Background
- Inflammation of large airways of the lung
- PNA must be excluded by clinical evaluation or by CXR
- If all 5 are negative PNA is safely excluded:
- 1. HR >100
- 2. RR >24
- 3. Temp >38 (100.4)
- 4. Exam findings c/w focal consolidation, egophony, or fremitus
- 5. Age >64yr
- If all 5 are negative PNA is safely excluded:
Epidemiology
- Viruses are most common cause
- Influenza, paraflu, RSV, corona, adeno, rhino
- Bacterial cause occurs in <10% of cases
- Mycoplasma, C. pneumoniae, pertussis (1% of bronchitis cases)
Diagnosis
- Cough, with or without sputum, without e/o PNA, common cold, or Asthma
- Cough >5d is more suggestive of bronchitis than common cold
- Cough may persist for 10-20d
- Cough >3wk suggests asthma, COPD, pertussis, postnasal drip, GERD
- Often follows URI
Work-Up
- CXR only indicated in elderly or suspicion for PNA
Treatment
- American College of Chest Physicians 2006 Guidelines[1]
- Routine treatment w/ abx is not justified
- Antitussive agents can be useful (codeine, dextromethorphan)
- In individuals without comorbidities antibiotics have no improvement in symptoms or duration [2]
- Do not treat patients with antibiotics unless:[3]
- older than 65 years
- Recent hospitalizations in the past year
- Diabetes
- On chronic steroids
- If treating based upon the above criteria then a 5 day treatment is preferred [4]
- Bronchodilators only useful if there is wheezing
Source
- ↑ Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.
- ↑ Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37
- ↑ Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337
- ↑ El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22