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Acute bronchitis

INTRODUCTION

Acute bronchitis, to be distinguished from exacerbations of chronic bronchitis, is one of the most common conditions encountered in clinical practice. Acute bronchitis is also one of the most common causes of antibiotic abuse, since this diagnosis usually leads to a prescription for antibacterial agents, but is generally caused by a virus [1-3].

Most reports indicate that more than 60 to 70 percent of patients with acute bronchitis who seek care are given antibiotics. This has resulted in a campaign to dissuade physicians from this practice through guidelines from the American College of Physicians [4] and the Centers for Disease Control and Prevention (CDC) [5]. Both state unequivocally that the only indication for antibacterial agents in acute bronchitis is pertussis. Surveys of practice show very modest success of these campaigns, since the frequency of prescriptions for antibiotics for acute bronchitis have decreased from approximately 75 percent to 60 percent in the past decade [6], but the choice of antibiotics has changed towards more frequent use of broad-spectrum agents, from approximately 20 to 60 percent [6,7].

Acute bronchitis caused by microbial infection will be reviewed here. Exacerbations of chronic bronchitis are discussed separately. (See "Diagnosis and treatment of infection in acute exacerbations of chronic obstructive pulmonary disease".)

MICROBIOLOGY

The usual causes of acute bronchitis are viral infections of the upper airways including influenza A and B, parainfluenza, coronavirus (types 1-3), rhinovirus, respiratory syncytial virus, and human metapneumovirus [1,8]. Several case series examined the etiology of acute bronchitis in patients without underlying lung disease [9,10]. An etiologic agent was established in only a minority of cases (29 percent of 42 episodes in one study [10], 16 percent of 113 patients in another [11]); viruses were the most common agents identified.

There is sometimes suspicion that the bacterial pathogens that cause pneumonia, such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, or even gram-negative bacilli, can also cause acute bronchitis. However, there is no convincing evidence to support the concept of "acute bacterial bronchitis" caused by these pathogens in adults, with the exception of patients with airway violations such as tracheostomy or endotracheal intubation, or those with exacerbations of chronic bronchitis. (See "Diagnosis and treatment of infection in acute exacerbations of chronic obstructive pulmonary disease".)
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