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Adult acute bronchitis

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Health status (general condition, auscultation) X-ray (to exclude pneumonia) CRP (high CRP refers to bacterial aetiology or pneumonia) ... – PowerPoint PPT presentation

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Title: Adult acute bronchitis


1
Adult acute bronchitis
  • Acute inflammation of the mucous membranes of the
    trachea and bronchi (duration lt 4 weeks)
  • productive cough
  • upper respiratory tract symptoms
  • general symptoms (in 10 - 50)

2
Aetiology of acute bronchitis
  • Common respiratory tract viruses (80)
  • Bacteria (in about 20 of cases)
  • Pneumococci ( in 2 - 30)?
  • Haemophilus ( in 2 - 8)?
  • Mycoplasma (in 0.5 - 11)
  • Chlamydia (in 0 -18)
  • (Pertussis (in 0 - 7))

3
Diagnosis of acute bronchitis
  • The aim is to
  • identify, among all patients with cough, those
    with other illnesses needing specific treatment
    (e.g. pneumonia, sinusitis, asthma)
  • identify, among all patients with bronchitis,
    those who would benefit from antibiotics

4
(Differential) diagnosis
  • History (e.g. asthma)
  • Health status (general condition, auscultation)
  • X-ray (to exclude pneumonia)
  • CRP (high CRP refers to bacterial aetiology or
    pneumonia)
  • Sinus ultrasound (to exclude sinusitis)
  • Antibody testing (of a few representative
    patients if needed to establish an epidemic)
  • Easy access to a follow-up visit (inform your
    assistants!)

5
When is chest x-ray needed?
  • patient is particularly unwell
  • patient is particularly prone to pneumonia due to
    underlying disease, age or alcoholism
  • history of pneumonia within the preceding year
  • upper respiratory tract symptoms absent
  • patient requests x-ray (pneumonia can not be
    excluded on clinical symptoms and findings only)

6
Treatment of acute bronchitis
  • First choice no antibiotics!
  • Factors supporting antibiotic treatment
  • CRP gt 50 mg/l
  • patient is particularly unwell or becoming so
  • pyrexia of over weeks duration or patient
    pyrexial following a period of apyrexia
  • epidemiological state
  • patient is immunocompromised

7
Antimicrobial therapy of acute bronchitis 1
  • First choice
  • in most cases good effect on pneumococci is
    sufficient
  • penicillin resistance in pneumococci in Finland
    is low (R lt 1) (A)
  • penicillin V 1-1.5 mega units 8 hourly for 5 7
    days
  • for patients with penicillin allergy a first
    -generation cephalosporin

8
Antimicrobial therapy of acute bronchitis 2
  • Other choices
  • probable mycoplasma or chlamydia infection
  • doxycycline 100-150 mg daily for 5 7 days
  • a macrolide erythromycin 500mg 3 - 4 times
    daily, roxithromycin 150 mg twice daily,
    klarithromycin 250mg twice daily or azithromycin
    250 mg daily for 5 7 days
  • underlying chronic lung disease
  • amoxicillin, sulphatrimethoprim

9
Symptomatic treatment of acute bronchitis
  • Symptomatic treatment assists the patient to
    cope with his/her symptoms and thus aims at
    reducing the unnecessary use of antimicrobial
    agents
  • no benefit is gained on cough with codeine,
    salbutamol or dextromethorphan as compared with a
    placebo,
  • ...but cough improves considerably even during a
    placebo-treatment
  • patient often presents with additional symptoms,
    which can be eased with antihistamines,
    anticholinergic and/or sympatomimetic agents, but
    their benefit remains controversial!

10
Quality criteria to develop treatment
  • as a general rule a young, or middle-aged,
    previously well patient with bronchitis not to be
    prescribed antibiotics, at least not at the first
    consultation.
  • if antibiotics are considered for the treatment
    of bronchitis, CRP is to be determined first
  • follow-up appointment arrangements to be patient
    friendly
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