Acute Bronchitis

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This refers to an acute inflammation of the bronchial mucosa. It is often found in association with upper respiratory tract infection. Most cases do not require antibiotics, however, they may be prescribed if the patient’s SPO2 is less than 92% or if there is an underlying co-morbidity like malnutrition, measles, rickets, anaemia,  diabetes mellitus, chronic bronchitis or HIV/AIDS.

Causes

  • Viruses e.g. Influenza virus, Corona virus (common cold)
  • Bacteria e.g. Streptococcus pneumoniae, H. influenza, Moraxella catarrhalis, Staph. aureus (tends to cause post-influenza chest infections, including bronchitis)

Symptoms

  • Dry cough
  • Sputum production
  • Sore throat
  • Pleuritic chest pain
  • Low grade fever

Signs

  • Fever
  • Rhinorrhoea
  • Rhonchi (wheeze)  
  • Crepitations (rare)

Investigations

  • FBC
  • Sputum culture and gram stain
  • Sputum AFBs (2 samples) for tuberculosis if symptoms have lasted more than 2 weeks
  • Sinus X-ray for rhinosinusitis (with post nasal drip) as a possible cause for prolonged cough

TreatmentTreatment Objectives

  • To relieve symptoms
  • To treat suspected bacterial infection if any

Non-pharmacological treatment

  • Bed rest
  • Oral fluids to keep well hydrated
  • Humidified air or steam inhalation if necessary 

Pharmacological treatment 

 See sections below Referral Criteria

  • Refer all complicated cases of acute bronchitis to a specialist

Uncomplicated Acute Infections

1st Line Treatment

Evidence Rating: [C]

  • Paracetamol, oral,

Adults

500 mg-1g 6-8 hourly

Children

6-12 years; 250-500 mg 6-8 hourly

1-5 years; 120-250 mg 6-8 hourly

3 months-1 year; 60-120 mg 6-8 hourly

Or

  • Paracetamol, rectal, 

Adults

500 mg-1g 6-8 hourly

Children

6-12 years; 250-500 mg 6-8 hourly

1-5 years; 120-250 mg 6-8 hourly

3 months-1 year; 60-120 mg 6-8 hourly

Uncomplicated Acute Infections - for irritating or chesty coughs

  • Guaifenesin containing expectorant, oral, 

Adult 

200-400 mg 4 hourly (max. 2.4 g per day)

Children 

>12 years; 100-400 mg 4 hourly (max. 2.4 g per day)

6-11 years; 100-200 mg 4 hourly (max. 1.2 g per day)

2-5 years; 50-100 mg 4 hourly (max. 600 mg per day)

6 months-2 years; 25-50 mg 4 hourly (max. 300 mg per day)

Or 

  • Simple linctus, oral,

Adults (adult formulation)

5 ml 6-8 hourly

Children (paediatric formulation)

1 month-12 years; 2.5-5 ml 6-8 hourly

Or

  • Carbocysteine, oral, 

Adult

500-750 mg 6-8 hourly

Children

2-5 years; 62.5-125 mg 6 hourly 

<2 years; not recommended  

Uncomplicated Acute Infections-for non-productive or dry cough

  • Dextromethorphan containing cough preparations

Adult 

10-20 mg 6-8 hourly 

Children 

7-12 years; 15 mg 6-8 hourly (max. 60 mg per day)

4-6 years; 7.5 mg 6-8 hourly (max. 30 mg per day)

< 4 years; not recommended 

Or

  • Codeine containing cough preparations

Adult 

7.5 -20 mg 4-6 hourly as needed (max. 120 mg per day)

Children 

7-12 years; 1-1.5 mg/kg per day in 4-6 divided doses (max. 60 mg per day)

2-6 years; 1-1.5 mg/kg per day in 4-6 divided doses (max. 30 mg  per day)

< 2 years; not recommended

For Complicated Acute Infections with Co-morbidities or Secondary Bacterial Infection

1st Line Treatment

Evidence Rating: [C]

  • Amoxicillin (Amoxycillin), oral,

Adults

500 mg 8 hourly for 5-7 days

Children

6-12 years; 250 mg 8 hourly for 7 days

1-5 years; 125 mg 8 hourly for 7 days

<1 year; 62.5 mg 8 hourly for 7 days

Or

  • Amoxicillin + Clavulanic Acid, oral,

Adults

1 g 12 hourly for 5-7 days

Children

> 12 years; One 500/125 tablet 12 hourly for 7 days

4-12 years; 5 ml of 400/57 suspension 12 hourly for 7 days

1-4 years; 5 ml of 200/28 suspension 12 hourly for 7 days

3 months-1 year; 20 mg/kg (of amoxicillin) 12 hourly for 7 days 

< 3 months; 15 mg/kg (of amoxicillin) 12 hourly for 7 days 

For children double the dose of the above antibiotic in severe infections (bronchopneumonia)

Or

  • Erythromycin, oral, (for individuals allergic to penicillin)

Adults

250-500 mg 6 hourly for 7 days

Children

8-18 years; 250-500 mg 6 hourly 7 days

2-8 years; 250 mg 6 hourly 7 days

6 months-2 years; 125 mg 6 hourly 7 days

Or

  • Azithromycin, oral,

Adults

500 mg once daily for 3 days

Children

10 mg/kg once daily for 3 days

And 

  • Oxygen 

By nasal prongs, 2-6 L/min

Or 

Face mask, 4-8 L/min

Or 

Non-rebreather mask, 10-15 L/min