Acute bronchitis: How - And whether - To prescribe antibiotics

Acute bronchitis in patients without underlying lung disease is usually viral in origin; these patients should not be given an antibiotic unless a significant cough persists more than 7 to 14 days or there is strong evidence of bacterial infection. In these rare situations, erythromycin or doxycycline is a reasonable choice. Patients with underlying lung disease experiencing moderate or severe exacerbations of chronic bronchitis may benefit from antibiotics, as may those who have moderate to severe medical illnesses. These patients manifest at least two of the following: increasing dyspnea, increasing cough, or increasing sputum quantity/purulence. In these situations, good antibiotic choices are trimethoprim-sulfamethoxazole or doxycycline, or occasionally amoxicillin. Inappropriate prescribing of these and other antibiotics, as well as the unnecessary use of broad-spectrum agents, is expensive, puts patients at needless risk for side effects, and contributes to the growing problem of drug-resistant bacteria.