What are the current guidelines for the use of antibiotics in acute bronchitis?

For the management of acute bronchitis, antibiotics are not routinely offered, as symptomatic treatments are considered the mainstay ¹. The decision to prescribe antibiotics is guided by clinical assessment and, if available, C-reactive protein (CRP) test results ¹,⁴.

• CRP-Guided Prescribing:
  • If the CRP level is less than 20 mg/L, antibiotics should not be routinely offered ¹,⁴.
  • If the CRP level is between 20 mg/L and 100 mg/L, a delayed (back-up) antibiotic prescription may be considered ¹,⁴. A back-up prescription is for use at a later date if symptoms worsen ⁴.
  • If the CRP level is greater than 100 mg/L, antibiotic therapy should be offered ¹,⁴.
• Immediate Antibiotic Prescription:
  • An immediate antibiotic prescription should be offered if the person is systemically very unwell ¹.
  • An immediate or back-up antibiotic prescription can be considered if the person is at higher risk of complications, such as having a pre-existing comorbidity or being of older age and fulfilling certain criteria ¹.
• Antibiotic Choices and Duration (5-day course):
  • For adults aged 18 years and older:
    • The first-line choice is oral doxycycline: 200 mg on the first day, then 100 mg once a day for 4 days (5-day course in total) ¹. Doxycycline is not the first-choice antibiotic for pregnant women ¹.
    • Alternative first choices are oral amoxicillin (500 mg three times a day for 5 days, preferred in pregnant women), clarithromycin (250 mg to 500 mg twice a day for 5 days), or erythromycin (250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days, preferred in pregnant women) ¹.
  • For young people aged 12–17 years:
    • The first-line choice is oral amoxicillin: 500 mg three times a day for 5 days (preferred in young women who are pregnant) ¹.
    • Alternative first choices are oral clarithromycin (250 mg to 500 mg twice a day for 5 days), erythromycin (250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days, preferred in young women who are pregnant), or doxycycline (200 mg on the first day, then 100 mg once a day for 4 days, 5-day course in total) ¹. Doxycycline should not be given to young women who are pregnant ¹.
• Treatments Not Routinely Offered:
  • Do not offer an oral or inhaled bronchodilator (e.g., salbutamol) or an oral or inhaled corticosteroid unless the person has an underlying airway disease such as asthma ¹.
  • Do not offer a mucolytic (e.g., acetylcysteine or carbocisteine) to treat an acute cough associated with acute bronchitis ¹.
  • Do not offer rapid point-of-care microbiological tests or influenza tests to determine whether to prescribe antimicrobials ⁴.
• Self-Care and Safety-Netting:
  • Offer written advice, such as NHS information on Chest infection ¹.
  • Promoting self-care may help reduce antibiotic prescriptions and general practice consultations ¹.
  • Safety-netting advice is important to ensure medical help is sought appropriately, especially when a back-up prescription is given ¹.