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Acute Bronchitis

NICE CKS Chest infections - adult. Last revised: Jan 2025.

Background Information

A self-limiting LRTILower respiratory tract infection that causes bronchial airway inflammation

Viral infection (>90% of cases)
  • Respiratory pathogens (e.g, Rhinovirus, Adenovirus, Coronavirus, Influenza, Parainfluenza)

Bacterial infection (1-10% of cases)
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Rarer (usually in outbreaks): Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis 

  • Typically mild self-limiting illness (cough usually lasts ~3-4 weeks)

  • Pneumonia (secondary bacterial infection)
    • Commoner in older adults 
    • Sx: persistent fever/dyspnoea, abnormal lung findings 
 

Diagnosis Guidelines

Clinical features:
  • Cough +/- sputum production
  • Systemic upset
  • Fever may be absent or mild (high or persistent fever indicates pneumonia, influenza etc.)

Examination findings:
  • Chest can be clear
  • Wheezing
  • Focal crackles are characteristically absent (presence suggests pneumonia)

Consider the following investigations:
  • Pulse oximetry
  • C-reactive protein (if clinical diagnosis of pneumonia has not been made and there is uncertainty about antibiotic use)
  • Chest X-ray
 
 

The typical chest X-ray finding in acute bronchitis is normal​​​​​, which differentiates it from pneumonia.

Management Guidelines

Advise on self-care strategies:
  • Adequate fluid intake
  • Analgesia - paracetamol / ibuprofen

Advise that some people may wish to try the following:
  • Honey
  • Pelargonium (herbal medicine)
  • Expectorant (guaifenesin) - most useful for wet / productive cough
  • Cough suppressants (except codeine) - to relieve dry non-productive cough
    • Should be avoided if there is sputum / mucus production (will worsen the cough)

Do not routinely offer antibiotics to manage acute bronchitis
  • Acute bronchitis is usually self-limiting, where the cough resolves after ~3-4 weeks
  • Antibiotics do not make a large difference to the duration of symptoms

 

Do NOT offer the following to treat acute bronchitis (unless a separate indication is present):

  • Mucolytic (e.g. acetylcysteine, carbocisteine)
  • Bronchodilators
  • Corticosteroid (oral or inhaled)

  • Systemically very unwell
  • Higher risk of complications
    • Pre-existing comorbid condition (e.g. heart / lung / kidney / liver / neuromuscular disease, immunosuppression, cystic fibrosis)
    • >65 yo with ≥2 or >80 y/o with ≥1 of the following:
      • Hospital admission in the previous year
      • Diabetes
      • Congestive heart failure
      • Current use of oral corticosteroids
  • ↑ CRP level
    • CRP >100 mg/L → offer immediate antibiotic therapy
    • CRP 20-100 mg/L → consider delayed antibiotic prescription
    • CRP <20 mg/L → do not routinely offer antibiotics

1st line: doxycycline

2nd line:
  • Amoxicillin (safe in pregnancy and children)
  • Clarithromycin
  • Erythromycin
 
 

Doxycycline is contraindicated in pregnancy and in children. Amoxicillin is 1st line in these populations.

References

Author: Adams Lau
Reviewer:
Last edited: 28/08/25