ACUTE BRONCHITIS

ACUTE BRONCHITIS : 

ACUTE BRONCHITIS Prepared by Dr.Purohit & Dr.Jokhia.

CONN’S CURRENT THERAPY 2006 : 

CONN’S CURRENT THERAPY 2006 Antibiotics are not appropriate for adults with acute bronchitis. A guideline from the “ Centers for Disease Control and Prevention”, “American College of Physicians”, “Infectious Disease Society of America “ states … “routine antibiotic treatment of uncomplicated acute bronchitis is not recommended regardless of the duration of the cough” Antibiotics are not indicated for patients with purulent sputum or for smokers without underlying cardiopulmonary diseases. Antibiotics for SUSPECTED PERTUSIS do not hasten symptoms but prevents transmission to others. Albuterol shows promising results in patients with wheezing. No data to support the use of NSAIDs. Antihistaminics are no better than placebo. Results have been at best mixed for expectorants, mucolytics, and decongestant- antihistaminic combinations. Although evidence is mixed, antitussives such as guaiphenesin with codeine help coughing patients sleep at night.

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Rest and plenty of fluids. INFLUENZA : Start within 48 hours. Influenza A : amantadine and rimantidine Influenza A & B : oseltamivir and zanamivir. Education Patients given antibiotics previously ask it more often. Other study says patient’s satisfaction is dependent on patient’s perception that the physician spent enough time with them and that the illness and treatment was adequately explained, regardless if antibiotics were prescribed. Cough can last 10-14 days  3 to 4 weeks. Smocking cessation Inefficacy of antibiotics. Refer acute bronchitis as “chest cold” reduces patients expectations for antibiotics, it makes more long term sense to educate patients about the inefficacy of antibiotics for acute bronchitis.

PRESCRIPTION : 

PRESCRIPTION ALBUTEROL MDI 2 PUFFS 3 TIMES DAILY for 7 days for patients with wheezing. Acetaminophen 1 gm orally 3 times/day X 5 to 7 days. Ibuprofen 400-600 mg orally 3 times a day for5 to 7 days. Guifenesin with codeine 10 ml orally every 4 hours as needed at night. FOR INFLUENZA : Amantadine 100 mg BD for 5 days. Rimantadine 100 mg BD for 5 days.. Oseltamivir 75 mg orally BD for 5 days. Zanamivir 10 mg inhaled BD for 5 days. Patient education : Antibiotics are not beneficial and pose risks. Cough usually last 10-14 days but can be longer. Smocking cessation. Self contradictory Irrational combination Unviable !!

MERCK’S MANUAL 18TH EDITION : 

MERCK’S MANUAL 18TH EDITION Nearly all patients require symptomatic treatment like acetaminophen and hydration. Antitussive to facilitate sleep only. Patient’s with wheezing  albuterol or ipratropium for <= 7 days. ANTIBIOTICS : Amoxicilly 500 mg TID for 7 days. Doxycycline 100 mg bid for 7 days. Trimethoprime+ sulfomethoxazole(160/800) BID for 7 days. FOR patients with COPD or other serious pulmonary diseases who have at least 2 of the following: Increased cough Increased dyspnoea Increase in sputum purulence Cough resolve within 2 weeks. If persistant  X ray. Look for pertusis Postnasal drip Allergic rhinitis Cough variant asthama Some patients benefit from inhaled steroids for a few days if cough persists because of airway irritation.

INFECTIOUS DISEASES BY GORBACH BARTLETT BLACKLOW : 

INFECTIOUS DISEASES BY GORBACH BARTLETT BLACKLOW For fever aspirin or acetaminophen. Measures for preventing transmission. For cough :dextromethorphan 15 mg orally for 6 hours. For severe cough : codeine Expectorants are not advocated For wheezing  bronchodilators. Patients with serious associated chronic lung diseases may require ventilatory support and oxygen therapy. Antibiotics limited role. Majority for viral infections. M.Pneumonia and C.Pneumoniae  doxycyline or a macrolide Pertusis with erythromycin Influenza treated with rimantadine or amantadine S.Pneumonia.H.Influenzae, and B.Catarrhalis  beta lactam antibiotics. It will effectively eliminate these suspected pathogens in patients with acute bronchitis, but these are not placebo controlled trials that would be necessary to document clinical benefit. These organisms when found in expectorated secretions in patients with acute bronchitis, merely reflect colonization of the upper airways. Properly controlled trials have demonstrated that doxycyline, tetracycline and erythromycin confer no benefit in terms o the duration of cough, duration of sputum production and loss of work.

http://www.aafp.org/afp/2002/0515/p2039.html : 

http://www.aafp.org/afp/2002/0515/p2039.html Protussives and antitussives Protussive Terbutaline (brethine), amiloride (midamor), and hypertonic saline Clinical utility questionable Antitussive An antihistamine would be used to treat cough associated with allergic rhinitis, A decongestant or an antihistamine would be selected for cough associated with postnasal drainage, and A bronchodilator would be appropriate for cough associated with asthma exacerbations. ANTIBIOTICS Clinical trials on the effectiveness of antibiotics in the treatment of acute bronchitis have had mixed results and rather small sample sizes.

Reviews and Meta-analyses of Antibiotic Therapy for Acute Bronchitis : 

Reviews and Meta-analyses of Antibiotic Therapy for Acute Bronchitis MacKay Some studies showed statistical differences with antibiotic therapy, but there was no clinical significance Fahey, et al  Antibiotic therapy did not improve cough or clinical status, and patients had more side effects than those who did not take antibiotics. Smucny, et al  Antibiotic therapy resulted in shorter duration of cough and decreased likelihood of continued cough. Bent, et al  Antibiotic therapy decreased duration of cough by 12 hours. Smucny, et al  Antibiotic-treated patients were less likely to have cough, be unimproved, or have abnormal pulmonary findings; they also had shorter duration of cough and subjective ill feeling.

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Patients often expect antibiotic therapy for uncomplicated acute bronchitis. However, patient satisfaction does not depend on receiving an antibiotic. Instead, it is related to the quality of the physician-patient visit.

“POSSIBLE MODEL GUIDELINE” : 

“POSSIBLE MODEL GUIDELINE”

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Antibiotics are not appropriate for routine cases. For cough :dextromethorphan 15 mg orally for 6 hours. For severe cough : codeine Albuterol MDI 2 PUFFS 3 TIMES DAILY for 7 days for patients with wheezing. Acetaminophen 1 gm orally 3 times/day x 5 to 7 days. Or Ibuprofen 400-600 mg orally 3 times a day for5 to 7 days. Antihistaminics are no better than placebo Rest and plenty of fluids Education Spend enough time Cough can last 10-14 days  3 to 4 weeks. Smocking cessation Inefficacy of antibiotics. For patients with copd or other serious pulmonary diseases who have at least 2 of the following: Increased cough Increased dyspnoea Increase in sputum purulence For cardiopulmonary diseases. Amoxicilly 500 mg tid for 7 days. Doxycycline 100 mg bid for 7 days. Trimethoprime+ sulfomethoxazole(160/800) bid for 7 days.

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THANK YOU !!