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Nine randomized, double-blind, placebo-controlled trials were undertaken between 1966 and 1995 to determine antibiotic effectiveness in treating acute bronchitis. 45 Whereas two studies reported improvement in symptoms, and a trend toward resolution of cough and clinical improvement at follow-up were noted, systematic review did not find statistical benefit for antibiotic treatment. Most cases of acute bronchitis are self-limited, and patients recover at the same rate regardless of antibiotic treatment. Even if there is evidence of bacterial infection with B. pertussis, M. pneumoniae, C. pneumoniae, or S. pneumoniae, there is no evidence that antibiotic treatment hastens improvement. There is some evidence that older adults and patients with underlying chronic obstructive pulmonary disease (COPD) benefit from antibiotic treatment for acute bronchitis.56 However, until controlled trials are performed, routine antibiotic use even in these patients cannot be recommended.

There is evidence that bronchodilators are useful in treating acute bronchitis, compared with either placebo or erythromycin. Patients' report decreased cough and faster return to work when treated with oral or inhaled albuterol.78 A significant bronchodilator response, as measured by an improvement in PEF or FEV of greater than 10 to 12 percent, may be useful in determining whether outpatient treatment is useful. The administration of inhaled (metered dose inhaler, 2 puffs q 4 to 6 h) or oral (2 mg tid to qid) albuterol should be considered in acute bronchitis, especially if reversible bronchospasm is present.

Amantadine has been shown to shorten the duration and severity of influenza A in up to half of patients who receive it within 48 h of symptom onset (see Chap 150,

"Common Viral Infections"). Amantadine or rimantadine may be effective in treating acute bronchitis caused by this agent. Aerosolized ribavirin may also be helpful in patients with acute bronchitis due to RSV.

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