Acute Bronchitis for Adult and Pediatric Patients Algorithm

Strategies to reduce antibiotic use for acute bronchitis: Symptoms consistent with acute bronchitis lasting > 5 days: 1. Use delayed prescription Conduct Differential Diagnosis: Cough, sputum production, strategies Pneumonia, asthma, exacerbation of dyspnea, nasal congestion, COPD, heart failure, upper respiratory 2. Discuss the expected course headache, and fever tract infection of illness and cough duration (2-3 weeks) Symptoms are not consistent 3. Explain that the illness is Acute bronchitis is likely either with acute bronchitis typically caused by a virus viral or Mycoplasma or (Bronchitis is ruled out as a (90%) and not bacteria Chlamydia pneumonia diagnosis)

4. Explain that antibiotics do not significantly shorten illness Are the following Antibiotics are not duration and are associated Are the following symptoms present: indicated for treatment. with adverse effects and symptoms present: Dyspnea, bloody or rusty antibiotic resistance malaise, rhinorrhea, mild sputum, pulse > 100 or paroxysmal cough, bpm, RR > 24 bpm, File TM. Acute bronchitis in Adults. In: excessive lacrimation, T > 100°F (37.8°C), Focal UpToDate, Bond S, Aronson MD (Ed), conjunctival infection? UpToDate, Waltham, MA. (Accessed on consolidation, egophony,

April 13, 2017.) Kinkade S, Long NA. Acute or fremitus on chest Bronchitis. Am Fam Physician. Yes 2016;94(7):560-565. Lexicomp Online® , examination, delirium if Dosing: Adult and Pediatric, Hudson, Ohio: age > 75? Lexi-Comp, Inc.; April 13, 2017. Yes, pertussis is likely No

Supportive care and symptom management Chest radiography • Antitussives: Dextromethorphan, is indicated Adult: guaifenesin (adults only),

1. Azithromycin 500 mg x1 day, then benzonatate (Rx only) 250 mg x4 • Expectorants: Guaifenesin Infiltrate No Infiltrate 2. Erythromycin 500 mg QID x14 • Consider Beta2-Agonists if 3. Clarithromycin 500 mg BID x14 ll ll underlying history of lung 4. If macrolide contraindicated: disease or wheezing or airway Bactrim®DS BID x14 Refer to CAP/HAP obstruction on exam guidelines • Analgesics/Antipyretics: APAP or Pediatric: ibuprofen for fever and pain 1. Azithromycin 10 mg/kg x1 (Max Pneumonia ruled 500), then 5 mg/kg x4 (Max 250) out of differential 2. Erythromycin 40-50 mg/kg/day in Cold and cough medications are not

4 divided doses (Max 2 g/day) recommended in children under 4 3. Clarithromycin 7.5 mg/kg/dose years old: Q12H x7 (Max 500/dose) Fluids, APAP/ibuprofen (fever/pain 4. Bactrim® 4mg/kg/dose Q12H x14 control), saline nasal spray, and if >1 year honey (antitussive).