Most cases of acute bronchitis are viral; where bacteria are responsible the usual pathogens are Streptococcus pneumoniae and/or Haemophilus influenzae. It is questionable if there is role for antimicrobials in uncomplicated acute bronchitis but amoxicillin, a tetracycline or trimethoprim are appropriate if treatment is considered necessary.
In chronic bronchitis, suppressive chemotherapy, generally needed only during the colder months (in temperate, colder regions), may be considered for patients with symptoms of pulmonary insufficiency, recurrent acute exacerbations or permanently purulent sputum. Amoxicillin or trimethoprim is suitable for treatment.
For intermittent therapy, the patient is given a supply of the drug and is told to take it in full dose at the first sign of a 'chest' cold, e.g. purulent sputum, and to stop it after 3 days if there is rapid improvement. Otherwise, the patient should continue the drug until recovery takes place. If the exacerbation lasts for more than 10 days, there is a need for clinical reassessment.
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