Consider the following when making your decision:

• If you have no other health problems, experts recommend that antibiotics not be used for acute bronchitis.¹ Since more than 90% of the cases of acute bronchitis in healthy people have a nonbacterial cause, antibiotics are largely not effective for acute bronchitis.
• If you have chronic obstructive pulmonary disease (COPD), other chronic respiratory problems (such as asthma or cystic fibrosis), or heart failure, and you develop acute bronchitis, treatment may be different. Talk with your health professional.

What is acute bronchitis?

Acute bronchitis is inflammation of the tubes that carry air to the lungs (bronchial tubes). When these tubes get inflamed, they swell and produce more mucus. The swollen tubes and increased mucus trigger cough and may make it difficult for you to breathe. Acute bronchitis usually develops rapidly and lasts 2 to 3 weeks in otherwise healthy people.

What causes acute bronchitis?

Acute bronchitis is usually caused by a virus. It is more common during the winter months and often develops after an upper respiratory tract infection such as influenza or a cold. Respiratory syncytial virus (RSV) may be a cause, especially in adults older than 65. Only about 10% of cases of acute bronchitis are caused by bacteria.¹

Acute bronchitis can also be caused by exposure to smoke, chemicals, or air pollution, all of which can irritate the bronchial tubes, or it may result from accidentally inhaling (aspirating) food or vomit.

What are the risks of acute bronchitis?

In otherwise healthy people, acute bronchitis poses little risk. Pneumonia is the most serious complication and is most likely to develop if you have a long-term (chronic) disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, or heart failure, or a weak immune system. Treatment for people with these conditions generally depends on their condition.

How effective are antibiotics for acute bronchitis?

Research on antibiotics and acute bronchitis in otherwise healthy people reports that antibiotics modestly reduce cough after 1 to 2 weeks, but they have no effect on a night cough, a cough with mucus, or quality of life. In people who also have symptoms of a common cold and have been ill less than a week, antibiotics generally are not effective.^{2, 3}

What are the risks of using antibiotics?

Antibiotics have side effects, such as diarrhea, nausea, upset stomach, vomiting, sore mouth, skin rash, dizziness, and headache. Frequent and/or inappropriate use of antibiotics can lead to antibiotic resistance-the bacteria change in ways that allow them to survive despite the medication, so that the antibiotic may not work the next time it is used.

Your choices are:

• Take antibiotics for acute bronchitis.
• Use home treatment (including over-the-counter medicines) to relieve cough and other symptoms, and allow the disease to run its course.

The decision about whether to take antibiotics for acute bronchitis takes into account your personal feelings and the medical facts.

Deciding about antibiotics for acute bronchitis

Reasons to take antibiotics

Reasons not to take antibiotics

Antibiotic treatment may result in a slightly shorter duration of coughing.2, 3 Whooping cough is suspected. Pneumonia is suspected. Your condition does not improve after 14 to 21 days. You have chronic obstructive pulmonary disease (COPD) or asthma. Are there other reasons why you might take antibiotics?

Acute bronchitis usually clears up on its own in 2 to 3 weeks. Experts recommend not using antibiotics if you have no other health conditions. Increased antibiotic use raises the risk for antibiotic-resistant bacteria. Side effects of antibiotics include diarrhea, nausea, upset stomach, vomiting, sore mouth, skin rash, dizziness or headache, and an increased sensitivity to sun (sunburn easily). Cost may not be worth benefits. Are there other reasons why you might not take antibiotics?

These personal stories may be helpful in making your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking antibiotics for acute bronchitis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My acute bronchitis followed the flu or another upper respiratory tract infection.	Yes	No	Unsure
I have been using home treatments for more than 14 days and have not improved.	Yes	No	Unsure
My health professional thinks I may have whooping cough or pneumonia.	Yes	No	Unsure
I am worried that I might be sick with something more than acute bronchitis.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use antibiotics.

Check the box below that represents your overall impression about your decision.

Leaning toward using antibiotics

Leaning toward NOT using antibiotics

Citations

1. Gonzales RG, et al. (2001). Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: Background. Annals of Internal Medicine, 134(6): 521–529.

2. Wark P (2005). Acute bronchitis, search date March 2006. Online version of Clinical Evidence (14): 1–10.

3. Fahey T, et al. (2006). Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

Author	Sabra L. Katz-Wise
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
Last Updated	August 31, 2006