If you've ever had a bad cough that won't quit, you might have been prescribed antibiotics. But here's the truth: for most cases of Acute bronchitisan acute inflammatory condition of the bronchial tubes typically caused by viral infections, antibiotics won't help-and they might even harm you.
What Exactly Is Acute Bronchitis?
Acute bronchitis is the most common reason adults visit their doctor for a cough. According to American Academy of Family Physicians, it accounts for about 10 million outpatient visits each year in the U.S. The condition usually starts with a viral infection like a cold or flu. Your bronchial tubes get inflamed, leading to that persistent cough. But unlike pneumonia, acute bronchitis doesn't typically cause high fever, chest pain, or trouble breathing. Most people recover on their own within a few weeks.
Here's the key detail: 90-95% of acute bronchitis cases are viral. That means antibiotics-drugs designed to kill bacteria-have zero effect. The CDC states clearly: "Antibiotics won't help you get better if you have acute bronchitis" in 95% of cases. Despite this, doctors still prescribe antibiotics for acute bronchitis far too often. Why? Because patients expect them, and doctors feel pressured to do something.
Why Antibiotics Are Harmful (Not Helpful)
A 2017 Cochrane review analyzed 9 randomized trials with 5,639 patients. The results were clear: antibiotics only reduced cough duration by 0.6 days on average. That's less than a day of relief. Meanwhile, antibiotics cause side effects like nausea, diarrhea, or allergic reactions. For every 14 patients treated with antibiotics for acute bronchitis, one experiences harm. The Antibiotics also contribute to antibiotic resistance-a growing global health crisis. The CDC estimates 46 million unnecessary antibiotic prescriptions happen each year for respiratory infections like bronchitis, leading to 2.8 million antibiotic-resistant infections and 35,000 deaths annually in the U.S.
Dr. Mark Ebell, lead author of the 2016 AAFP guideline, puts it bluntly: "The evidence is clear that antibiotics provide minimal benefit for acute bronchitis while exposing patients to unnecessary risks. We must shift patient expectations through better communication about the natural history of cough."
What Actually Works for Cough Relief
Since antibiotics don't help, focus on symptom management. Here's what science supports:
- Rest: Your body needs energy to fight the infection. Skip workouts and let yourself sleep.
- Hydration: Drink 8-10 glasses of fluids daily. Water, herbal tea, or broth thins mucus and soothes your throat.
- Honey: For adults, take 2.5-10 mL as needed. A 2018 JAMA Pediatrics trial found honey works as well as dextromethorphan for cough suppression. Never give honey to children under 1 year due to botulism risk.
- Humidifiers: Use cool mist humidifiers to moisten airways. Breathing steam from a bowl of hot water (with caution to avoid burns) also helps.
- OTC meds: Ibuprofen (Advil®) or acetaminophen (Tylenol®) for pain and fever. For cough, dextromethorphan 15-30 mg every 6-8 hours (max 120 mg daily) is effective for adults and kids over 6.
The Cleveland Clinic 2023 guide specifies: "Use ibuprofen or acetaminophen every 6-8 hours for pain and fever, following package dosing instructions (max 3,000 mg acetaminophen daily for adults without liver disease)."
When to See a Doctor
Most acute bronchitis cases resolve on their own. But call your doctor if you experience:
- Fever over 100.4°F (38°C) lasting more than 3 days
- Cough lasting longer than 3 weeks
- Coughing up blood or thick green/yellow mucus
- Chest pain or trouble breathing
- Wheezing or shortness of breath
These symptoms could signal pneumonia or another serious condition. The Modified Medical Research Council questionnaire helps doctors rule out pneumonia-96% accurate when patients have no vital sign abnormalities.
Common Myths About Bronchitis
Let's clear up some confusion:
- Myth: "Coughing means I need antibiotics." Fact: Coughing is your body's way of clearing mucus. Viral infections cause most coughs, and antibiotics don't touch viruses.
- Myth: "Green mucus means bacterial infection." Fact: Mucus color changes during illness but doesn't indicate bacterial infection. The AAFP guideline states green mucus is common in viral bronchitis.
- Myth: "Antibiotics will speed up recovery." Fact: The Cochrane review found only 0.6-day reduction in cough duration. The risks outweigh the tiny benefit.
Why don't antibiotics work for acute bronchitis?
Most acute bronchitis cases (90-95%) are caused by viruses. Antibiotics only work on bacterial infections, so they have no effect on viral illnesses. A 2017 Cochrane review of 5,639 patients found antibiotics only reduced cough duration by 0.6 days on average-hardly worth the risk of side effects.
How long does a bronchitis cough last?
Coughing usually lasts 2-3 weeks. About 50% of people still cough at 10 days, 26% at 14 days, and 11% at 21 days. The AAFP notes that setting realistic expectations is key-many patients expect to feel better in a few days, but the body needs time to heal.
Is honey safe for children with bronchitis?
Honey works well for cough relief in children over 1 year old. A 2018 JAMA Pediatrics trial showed honey was as effective as dextromethorphan for kids. But never give honey to infants under 1 year due to the risk of botulism. For babies, use saline drops and a humidifier instead.
What's the difference between acute bronchitis and pneumonia?
Acute bronchitis affects the bronchial tubes, causing cough with mucus but no fever or breathing trouble. Pneumonia involves lung infection, causing high fever, chest pain, and shortness of breath. Doctors use physical exams and chest X-rays to tell them apart. The Modified Medical Research Council questionnaire has 96% accuracy for ruling out pneumonia when vital signs are normal.
Should I take cough medicine for bronchitis?
Over-the-counter cough medicines have limited benefits. Dextromethorphan (like Robitussin DM) may help reduce cough frequency slightly. But guaifenesin (Mucinex) has inconsistent results. Avoid codeine-containing cough syrups for children under 12-the FDA banned them in 2018 due to safety risks. For most people, rest, hydration, and honey are safer and just as effective.
The Choosing Wisely campaign, launched by the American Board of Internal Medicine Foundation in 2012, lists "Don't prescribe antibiotics for upper respiratory infections including acute bronchitis" as its top recommendation for primary care physicians. With 76% of providers now following this principle, antibiotic misuse for bronchitis is slowly declining. But there's still work to do. By understanding what truly helps-like honey, hydration, and patience-you can avoid unnecessary drugs and protect yourself from antibiotic resistance.