Hood K, Fashner J, 1998;46(6):469–475. 2009;103(6):902–906. 94/No. King TS, Br J Gen Pract. Cochrane Database Syst Rev. Acute Bronchitis. Moragas A, Spaar A, Regnery A, Print. et al. Since 2005, the National Committee for Quality Assurance has recommended avoidance of antibiotic prescribing for acute bronchitis as a Healthcare Effectiveness Data and Information Set Measure.27 All major guidelines on bronchitis, including those from the American College of Chest Physicians, recommend against using antibiotics for acute bronchitis unless the patient has a known pertussis infection.2,22 The American Academy of Pediatrics recommends that antibiotics not be used for apparent viral respiratory illnesses, including sinusitis, pharyngitis, and bronchitis.28 Despite these recommendations, antibiotics are often prescribed for acute bronchitis.29, Over-the-counter medications are often recommended as first-line treatment for acute cough. SARAH N. DALRYMPLE, MD, is an assistant professor of family medicine at the University of Virginia Department of Family Medicine. Barrett B, et al. 52. 2006;129(1 suppl):95S–103S. Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 32. Five things physicians and patients should question. 2011;17(suppl 6):E1–E59. Briars LA. Distribution of bacteria on hands and the effectiveness of brief and thorough decontamination procedures using non-medicated soap. J Pharm Pharmacol. et al. Das RR. et al. Kawamura T, De Sutter AI, Yale SH, Antibiotics for acute bronchitis. Effect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial. Günther J, Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. Effectiveness of alcohol-based hand disinfectants in a public administration: impact on health and work performance related to acute respiratory symptoms and diarrhoea. Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. Rücker G, These images are a random sampling from a Bing search on the term "Pediatric Acute Cough." Evertsen J, 2011;(7):CD006207. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996–2010. Aglipay M, Beiler J, Ducharme F. Steurer J, BMC Infect Dis. 2014;(3):CD000245. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. et al. Beardsmore C. 59. Fleming-Dutra KE, Acute bronchitis is most often caused by a viral infection.3,4 The most commonly identified viruses are rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus.3 Bacteria are detected in 1% to 10% of cases of acute bronchitis.3–5 Atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis, are rare causes of acute bronchitis. Hickner J. 62. Bolser DC. Cochrane Database Syst Rev. Nasal Saline Irrigation. Phillips TG, van Vugt SF, Single and multiple viral infections in lower respiratory tract infection. Copyright © 2019 by the American Academy of Family Physicians. Approximately 10% of patients presenting with a cough lasting at least two weeks have evidence of B. pertussis infection.7,8 During outbreaks, pertussis detection is more likely in children and those with prolonged coughs.6,9 Antibiotics can eradicate B. pertussis from the nasopharynx. Hersh AL, Kenealy T, Simasek M, Eccles R. Motschall E, Kirkpatrick GL. Schumacher H, 24. van Vugt SF, 73. et al. A second trial showed decreased cough frequency (100% of the guaifenesin group vs. 94% of the placebo group; P = .5) and improved cough severity (100% of the guaifenesin group vs. 91% of the placebo group; P = .2) at 36 hours, and reduced sputum thickness (96% of the guaifenesin group vs. 54% of the placebo group; P = .001). Chambers ST, 45. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. The role of antibiotics is limited. 22. Steurer-Stey C, 2014;(11):CD001831. Hao Q, Cochrane Database Syst Rev. Smith SM, Am Fam Physician. Curran MD, ProREAL Study Team. GRACE Project Group. Altunaiji S, Smith SM, Acetaminophen (paracetamol) for the common cold in adults. 20. Wu T, Smucny J, Timmer A, Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold. Pelargonium sidoides extract for treating acute respiratory tract infections. 70. Zhang J, Intranasal ipratropium bromide for the common cold. Simancas-Racines D, Reinecke S, Becker LA. The primary diagnostic consideration in patients with suspected acute bronchitis is ruling out more serious causes of cough, such as asthma, exacerbation of chronic obstructive pulmonary disease, heart failure, or pneumonia. et al. et al. 17. Bistrup LA, Christ-Crain M, Banerjee I. Does inhaling menthol affect nasal patency or cough? Taylor JA, National Center for Health Statistics. Johnstone J, The common cold. Respir Med. Chest. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Hom J, firstname.lastname@example.org for copyright questions and/or permission requests. 37. Guerra CV, Investigation of the effect of oxymetazoline on the duration of rhinitis. Del Mar CB, Evid Based Complement Alternat Med. Becker LA, Cho HM, PIPS Investigators. honey (for children 12 months and older). Lammens C, et al. 2014;174(6):1011]. Baumgardner DJ, Kawamura T, Linde K, Houghton T, Altunaiji S, Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Hemilä H. Crowell KR, van Driel ML, Callahan-Lyon P, et al. ; Dykewicz MS, Additionally, there is no evidence that hydrocodone is useful in children. Guaifenesin is a commonly used expectorant. et al. GRACE Project Group. Skoupá J, Cochrane Database Syst Rev. 1998;279(24):1962–1967. Fitzgerald JT, Alfaleh K. Littmann M, Nexoe J, Jefferson T, ; Bao B, Cochrane Database Syst Rev. Arch Pediatr Adolesc Med. 19. High fever; moderate to severe ill-appearance; hypoxia; and signs of lung consolidation, such as decreased breath sounds, bronchial breath sounds, crackles, egophony, and increased tactile fremitus, are concerning for pneumonia. Halcomb WW. et al. Timmer A, 53. Villasis-Keever M, Little P, Curtis N, 2010;82(11):1345–1350. Introduction to acute cough. 30. 41. 1996;23(4):657–675. 1995;13(1):8–12. 13. Ganshorn H, ; Lipsky, et al. Antibiotics have no role in the treatment of the common cold. Medina MJ, Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi (large and medium-sized airways) of the lungs. Oduwole O, 35. J Fam Pract. Acetaminophen (paracetamol) for the common cold in adults. Current estimates from the National Health Interview Survey, 1996. Kenia P, U.S. Food Drug Administration. Immediate, unlimited access to all AFP content. Held U, Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. et al. Efficacy of cough suppressants in children. Consumption of a fermented dairy product containing the probiotic. Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices. 2000;133(4):245–252. Barrett BP, 6. Butler CC, Pierce RJ. AlBalawi ZH, Davis DR, Held U, 2013;11(1):5–13. The studies of adults had mixed results, but the findings suggest that beta2 agonists should be avoided if there is no underlying history of lung disease or evidence of wheeze or airway obstruction. Lower-quality evidence suggests that Lactobacillus casei may be beneficial in older adults. Wootton DG, American Academy of Pediatrics. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. 36. et al. Cochrane Database Syst Rev. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. Chong A, Respiratory tract infections in children in the community: prospective online inception cohort study. Verheij TJ, Del Mar CB, 2010;19(3):237–241. Ericson K, Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. CMAJ. Halablab MA, 27. et al. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see It should not be used in children younger than five years. Hueston WJ, 20. et al. Cochrane Database Syst Rev. KATHARINE C. DEGEORGE, MD, MS; DANIEL J. Singh M, However, beta2 agonists may have some benefit in certain adults, especially those with wheezing at the time of evaluation who do not have a previous diagnosis of asthma or chronic obstructive pulmonary disease. Udoh EE, Ebell MH, Arroll B. Patients and clinicians may underestimate the time required to fully recover from acute bronchitis.15 The duration of acute bronchitis–related cough is typically two to three weeks, with a pooled estimate of 18 days in one systematic review.15 This corresponds to results of a prospective trial, which found that patients who had a cough for at least five days had a median of 18 days of coughing.16, On physical examination, patients with acute bronchitis may be mildly ill-appearing, and fever is present in about one-third of patients.4,11 Lung auscultation may reveal wheezes, as well as rhonchi that typically improve with coughing. Effect of high-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. Steurer J. Antihistamines for the common cold. Braun C. et al. Diagnosis and management of acute bronchitis. Choose a single article, issue, or full-access subscription. Parmar S, 50. Cohen M. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Treatment of the common cold with unrefined echinacea. 39. 1. et al. Thompson MJ, Werner S. 34. Consider using dextromethorphan, guaifenesin, or honey to manage acute bronchitis symptoms. Accessed June 19, 2019. https://www.aafp.org/afp/2012/0715/p153.html, 76. Diagnostic aid to rule out pneumonia in adults with cough and feeling of fever. Dykewicz MS, 2013;(1):CD000980. et al. Fam Med. Tondu F, Washing and drying of hands to reduce microbial contamination. Snell LM, Enlarge O'Brien J, Crowell KR, Print, Over-the-counter cold medications should not be used in children younger than four years because of potential harms and lack of benefit.5,6, Lack of benefit in 10 RCTs in children and observational studies of adverse effects, The use of hand sanitizer or hand washing is the most effective way to prevent the common cold.8,9, Systematic review of cluster RCTs and observational studies with variable risk of bias, Treatments with established effectiveness for cold symptoms in adults are limited to over-the-counter analgesics and decongestants with or without antihistamines (but not antihistamine monotherapy).6,22,25,27,31, Systematic reviews of RCTs of varying quality, Antibiotics are ineffective for treatment of the common cold in adults and children and should not be prescribed.46,47, Consistent findings of no benefit and increased adverse effects in systematic reviews of 11 RCTs, Codeine and other antitussives have not been proven effective for cough in adults.6,48,54, Systematic reviews and a clinical practice guideline from the American College of Chest Physicians, Safe and effective treatments for cold symptoms in children include nasal saline irrigation, menthol rub, and honey (for children 12 months and older).39,61,63,65. et al. 2019 Sep 1;100(5):281-289. 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