The Post-Antibiotic Era: Bronchitis


Part II of the when-not-to-use-antibiotics post will deal with another common ailment:  Bronchitis. We’ll be dealing with acute bronchitis, not chronic bronchitis due to long-term smoking, which is a different animal altogether.

The term bronchitis is fairly non-specific. It simply means inflammation of the bronchial tubes or airways. This inflammation can occur for several different reasons, most commonly viruses or irritants, but rarely from bacteria. Viruses that cause bronchitis include influenza, parainfluinza, adenovirus and respiratory syncitial virus (RSV).  Non-infectious causes of bronchitis include pollutants, chemicals, second-hand cigarette smoke and the like.

The hallmark of bronchitis is a cough, with or without mucus production. Depending on the cause, there may be fever, aches, headache and sore throat as well. The acute symptoms typically last less than two weeks, but the cough may linger  for several weeks after. You should call your healthcare provider for high fever, thick or bloody mucus, or trouble breathing, but otherwise seek simple symptomatic treatment. Lots of great ideas are on this CDC web page.

Note that I did not mention antibiotics as a treatment. Since the vast majority of acute bronchitis is viral-or irritant-induced, antibiotics will not improve symptoms or shorten the duration of illness. (Anti-viral treatments for influenza can help if started early). Treating bronchitis with antibiotics simply adds to the cost, exposes people to the potential for adverse reactions, and adds to the growing rates of antibiotic resistance.

The one exception is pertussis, aka whooping cough. It is bacterial and responds to certain antibiotics. It also has an excellent vaccine that you and your children should all be up-to-date on. It had virtually disappeared from the U.S., but recent drops in vaccination rates and changes in vaccine composition have led to its reemergence. It causes a very characteristic, severe cough that can last for months, hence its old name, the 100-day cough.

So what can you do to prevent bronchitis? Avoid smoking and second-hand smoke for you and your kids, practice good hand hygiene, and stay current on your vaccinations, including pertussis and the yearly influenza vaccination.

I’ve borrowed liberally from the CDC website in writing this post. They have a ton of great information for the interested reader.  I highly recommend it.

Dr. O

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