Acute viral bronchitis
Acute viral inflammation of the bronchi in immunocompetent adults without underlying COPD, asthma, or immunosuppression. The condition resolves on its own within 1–3 weeks in the great majority of cases.
ICD-10 J205 drugs
Also known as: Uncomplicated acute bronchitis
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- FAmoxicillinNot recommended · Penicillins with extended spectrumFor acute bronchitis in adults without COPD or other chronic lung disease, Amoxicillin and other antibiotics are not recommended: NICE NG120 (2019) and ACP/CDC 2016 advise against routine prescribing because the cause is almost always viral and antibiotics cause adverse reactions and drive resistance. The Cochrane 2017 review shows a small benefit: cough shorter by 0.46 days on average, 0.64 fewer days of illness, less cough at follow-up (RR 0.64; NNTB 6), but more adverse events (RR 1.20; 95% CI 1.05–1.36; NNTH 24); the authors call the benefit limited and to be weighed against harm and resistance. Post-viral cough lasts up to 3–4 weeks; this is normal, not a sign of bacterial infection. Per the label, Amoxicillin is contraindicated in penicillin allergy and after anaphylaxis to another beta-lactam; common adverse reactions are diarrhoea and nausea, rash occurs, antibiotic-associated colitis is rare; in infectious mononucleosis rash is especially frequent. Acute bronchitis is not among the indications in the Spanish label (only acute exacerbation of chronic bronchitis is). It is reasonable to discuss an antibiotic with a doctor if you are systemically unwell, breathless, have high fever for more than 3 days or are at high risk of complications (NICE NG120); COPD exacerbation and pneumonia are separate indications with their own rules.
- FClarithromycinNot recommended · Macrolide antibioticFor acute viral bronchitis in immunocompetent adults without comorbid pathology, antibiotics are not prescribed. NICE NG191 2023 and IDSA state that antibacterial therapy does not shorten cough duration or improve outcomes. Prescribing a macrolide for a simple viral upper respiratory infection or bronchitis is an example of irrational antibiotic use and increases the risk of selecting macrolide-resistant pneumococci.
- FMeropenemNot recommended · Carbapenem antibiotic for intravenous useMeropenem is an intravenous reserve antibiotic for inpatients, and in acute bronchitis it sometimes goes in for reassurance when the fever runs longer than expected. In bronchitis in an adult without chronic lung disease the cause is overwhelmingly viral, and a carbapenem does nothing to viruses. The Cochrane review of antibiotics for acute bronchitis (2017) found cough shortened by less than a day alongside a clear rate of adverse effects. The price of that reassurance is concrete: a line and a drip, the risk of Clostridioides difficile colitis, seizures as a rare labelled reaction, and selection of resistant flora that will make the carbapenem fail when it is genuinely needed. If meropenem has been offered for a cough without pneumonia, consider seeking a second opinion from another doctor.
- FNorfloxacinNot recommended · Second-generation fluoroquinoloneFor acute uncomplicated bronchitis in immunocompetent adults, norfloxacin is not prescribed. An antibiotic does not shorten cough duration in a viral infection, while a fluoroquinolone with severe and irreversible adverse effects (tendinitis, aortic aneurysm) is used only under strict indications. FDA 2018 explicitly restricts fluoroquinolone use in simple infections where alternatives exist or antibiotics are not indicated.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit