Principles of appropriate antibiotic use for treatment of acute bronchitis in adults

Evaluation of adults with an acute cough illness or a presumptive diagnosis of uncomplicated acute bronchitis should focus on ruling out pneumonia. In the healthy, nonelderly adult, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lung sounds, and chest radiography is usually not indicated. In patients with cough lasting 3 weeks or longer, chest radiography is warranted in the absence of other known causes. Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of duration of cough. In the unusual circumstance in which pertussis is suspected, a diagnostic test should be performed and antimicrobial therapy initiated. Patient satisfaction with care for acute bronchitis is most dependent on physician-patient communication rather than on whether an antibiotic is prescribed.