Bacteria least common cause of initial infection. Acute COPD exacerbations are usually self-limited, caused most commonly by viruses followed by bacteria, then Mycoplasma pneumoniae or Chlamydia pneumoniae. The treatment of acute bronchitis is mainly supportive. Patient education is extremely important. The use of antibiotics is very controversial.
Clinical studies are equivocal as to the efficacy of antibiotics.
Any decision to treat with antibiotics should be based on sound clinical judgement. Antibiotics should attack the probable pathogens causing acute bronchitis, minimize drug side effects, and maximize patient compliance. Strangely, tetracyclines have not been shown to be better than placebo in clinical trials. Of all the antibiotics, erythromycin or newer macrolides seem to be the preferred antibiotic for 10 to 14 days when the decision to treat is made. Tetracycylines appear ineffective Consider use of bronchodilators if reactive airways disease present Patients tended to cough less, make less sputum, use fewer over the counter cold remedies, and had improved physical examinations weeks later when treated empirically with antibiotics compared to placebo.