Antibiotics for bronchitis in adults and children

Bronchitis is an inflammatory disease of the bronchi, which can be caused by the following reasons:

• viral infection;

• bacterial infection;

• Mixed infection;

• Atypical pathogens;

• Chemical exposure (smoking, hazardous production);

• Allergic reaction.

In the vast majority of cases, bronchitis is a complication of a viral cold, so treating it with antibiotics is not only pointless, but also dangerous. Antimicrobials are powerless against viruses, in addition, they depress the immune system and prevent the body from fighting the threat on its own. The most reasonable tactic of behavior for viral bronchitis is bed rest, drinking plenty of water, warming procedures, taking immunostimulants and symptomatic treatment with expectorant drugs.

Treatment of bronchitis with antibiotics is advisable only in two cases:

• A bacterial infection has joined the viral infection, and the body is not able to cope with it for three weeks or more;

• The disease is chronic, often relapsing or atypical.

Thus, a diagnosis of bronchitis by no means automatically means that a person needs to be treated with antibiotics. Without a thorough examination and establishment of the causes of the disease, no medicines can be prescribed, especially to oneself. Depending on the type of bronchitis, a competent specialist will choose the best option for drug therapy.

Types of bronchitis

Acute bronchitis

This term refers to the inflammatory process in the bronchi, which arose against the background of seasonal SARS or influenza. A viral attack is a serious blow to the immune system, which bacteria living in almost any organism rush to take advantage of: staphylococci, pneumococci, streptococci. They multiply in the bronchi and cause first attacks of painful dry cough, and then stagnation of viscous sputum, which is difficult to get rid of.

Before resorting to extreme measures, it is necessary to try to help the patient cope with bronchitis on their own, with the help of rest, drinking plenty of water and symptomatic treatment with antitussive drugs (Sinekod, Libeksin), expectorants (Bromhexin, Lazolvan) and medical procedures (inhalations, mustard plasters, rubbing) . Of course, with a fever, a warming effect is unacceptable. Acute bronchitis usually resolves within two weeks.

Treatment of acute bronchitis with antibiotics is indicated in the following cases:

• Cough lasts more than three weeks in a row;

• The patient keeps subfebrile or febrile body temperature (37,5-38,5 C);

• Expectoration opaque, yellow-green, bloody, offensive;

• There are signs of severe intoxication of the body (nausea, loose stools, gray complexion, weakness, profuse sweating);

• Blood tests show leukocytosis, high ESR and a right shift of the formula;

• The patient complains of pain in the chest;

• When breathing, distinct wheezing is heard and intercostal retraction is visible.

Chronical bronchitis

Chronic bronchitis is considered to have lasted more than three months in total within two years. This disease is accompanied by a strong cough with copious discharge of bronchial mucus, is difficult to treat symptomatically and recurs at the first weakening of the immune system. A great danger is chronic obstructive bronchitis and chronic smoker bronchitis – these diseases often provoke the development of lung cancer. Allergic and asthmatic chronic bronchitis also require increased attention due to the risk of suffocation.

The treatment of such complex diseases is a topic for a separate discussion, and today we are discussing antibiotics. It is advisable to prescribe them to patients (especially the elderly and very young), in whom any hypothermia turns into a new outbreak of chronic bronchitis. The reason lies in a weakened immune system and a large colony of bacteria nesting in the bronchi. With the help of antibiotics, a preemptive blow should be struck at this hotbed so that a banal cold does not turn into a multi-day nightmare again.

Atypical bronchitis

In very rare cases, bronchitis is caused by anaerobic pathogens, such as, for example, chlamydia or mycoplasma. Atypical bronchitis occurs in people with weak immunity, the elderly, who have recently had another serious infectious disease. The insidiousness of anaerobic microorganisms lies in their amazing survivability, resistance to many antibiotics and a consistent, but very slow destructive effect on the respiratory system.

A person suffering from atypical bronchitis usually does not go to the doctor for a long time. The temperature is low, the cough is moderate, there is little sputum. But over time, he gets worse: pain in the chest and muscles, weakness, intoxication are added. The later such a patient finally visits the doctor and gets tested, the worse, because it takes months to fight anaerobic pathogens, even with the power of modern antibiotics.

Tactics for the treatment of bronchitis in adults

Depending on the type of bronchitis, the treatment is selected as follows:

• Acute viral bronchitis – bed rest, heavy drinking, immunostimulating and symptomatic treatment, refusal of antibiotics;

• Uncomplicated chronic bronchitis (less than four relapses per year) – antibiotics from the group of aminopenicillins or macrolides (with intolerance to penicillins);

• Complicated chronic bronchitis (more than four relapses per year, the patient’s age is over 65 years) – aminopenicillins, cephalosporins, macrolides;

• Chronic bronchitis with comorbidities (renal and / or heart failure, diabetes mellitus) – fluoroquinolones;

• Mycoplasma bronchitis – macrolides;

• Chlamydial bronchitis – tetracyclines, fluoroquinolones, macrolides.

List of antibiotics for bronchitis in adults

Modern therapists prescribe the following groups of antimicrobials to adult patients with bronchitis:

• Aminopenicillin;

• macrolides;

• Fluoroquinolones;

• Cephalosporins.

Treatment of bronchitis with simple penicillins and sulfonamides is currently not carried out due to their high toxicity and low efficiency due to the mutation of most pathogens.

Aminopenicillins – first-line antibiotics

The drugs of this group destroy the cell membrane of bacteria and, thereby, cause their death. Aminopenicillins are active against pneumococci, streptococci, staphylococci and most other bacteria that cause bronchitis. Why are they considered first-line antibiotics? Because in the human body there are no cells that are at least somewhat similar in the structure of the membrane to the cells of pathogenic bacteria. Thus, aminopenicillins destroy only the pathogen, and do not cripple healthy tissues.

Penicillins are the best antibiotics for treating bronchitis in adults and children, but even they have two drawbacks:

• Frequent side effects in the form of allergies;

• Low efficiency against mutated pathogens that have the enzyme beta-lactamase.

If nothing can be done about the first negative moment – you have to choose an antibiotic from another group – then scientists have learned to cope with the second. Beta-lactamase, which some especially insidious bacteria acquired in the process of evolution, destroys penicillins. That is, everything happens with precision, but vice versa – not antibiotics kill bronchitis, but bronchitis destroys antibiotics. To neutralize the beta-lactamase enzyme, sulbactam or clavulanate (clavulanic acid) is added to amoxicillin. These components are specific inhibitors of beta-lactamase, and therefore they synergize with penicillins, helping them fight bacteria.

The result of this discovery was the latest generation of aminopenicillins:

• Amoxiclav;

• Flemoxin Solutab;

• Augmentin;

• Ecoclave;

• Arlette.

The cost of these drugs varies from 50 to 500 rubles, depending on the brand. Keep in mind that the most affordable are powders and tablets of domestic production, on the packaging of which it is written: “amoxicillin + sulbactam” or “amoxicillin + clavulanic acid.

Macrolides – second-line antibiotics

Drugs of this group inhibit protein synthesis in the cells of pathogens, thereby preventing them from multiplying. This approach to the treatment of bronchitis in adults is optimal when it comes to chronic, protracted, often recurrent disease. Macrolides are also good because, unlike penicillins, they are able to penetrate anaerobic microorganisms. This means that antibiotics of the macrolide group can treat atypical forms of bronchitis caused by chlamydia and mycoplasma.

Macrolides have a long half-life, accumulate well in tissues and do not require frequent administration. They are usually well tolerated by patients and do not cause side effects even with long-term treatment of bronchitis. If the patient has an individual intolerance to penicillin antibiotics, then macrolides are the best choice.

Frequently used macrolides for bronchitis:

• Erythromycin;

• Azithromycin;

• Hemomycin;

• Midekamycin.

Erythromycin is a first-generation macrolide that initiated the development of antimicrobials in this group. A more advanced antibiotic, Azithromycin, is known under numerous trade names: Azitral, Azitrox, Azitrus, Azitsid, Sumamed. Moreover, the cost of a package of three capsules of domestic Azithromycin is 80-120 rubles, while the imported, widely advertised generic Sumamed costs 450-600 rubles.

Fluoroquinolones

Treatment of bronchitis with fluoroquinolones is permissible only in adult patients, and only in case of individual intolerance to first-line and second-line antibiotics. Fluoroquinolones have a very broad spectrum of activity, effectively destroy the DNA of bacteria, but very often cause allergies and give side effects. Long-term treatment with fluoroquinolones is impossible without maintenance therapy aimed at maintaining a healthy microflora of internal organs, otherwise dysbacteriosis and mycoses cannot be avoided.

For the treatment of bronchitis in adults, the following antibiotics of the fluoroquinolone group are used:

• Ofloxacin;

• Pefloxacin;

• Ciprofloxacin;

• Levofloxacin;

• Moxifloxacin.

The cost of the first generation fluoroquinolone, Ofloxacin, is cheap – 20-30 rubles per package, the most popular second-generation drug, Ciprofloxacin (Cifran, Tsiprolet) costs 80-120 rubles, and the third or fourth generation of fluoroquinolones (Levofloxacin and Moxifloxacin) are quite expensive antibiotics (400-1200 rubles).

Cephalosporins

Preparations of this group are considered reserve antibiotics in the treatment of bronchitis. They can be useful if the patient is allergic to all three of the above groups of drugs, or if complex antibiotic therapy is needed for highly complicated, protracted bronchitis. Cephalosporins act only on growing and multiplying bacteria, paralyzing the cell membrane and interfering with division. These antibiotics cause allergic reactions and dysbacteriosis almost as often as simple penicillins, so they also require maintenance therapy for long-term use.

Bronchitis in adults is treated with the following cephalosporin antibiotics:

• Cefazolin;

• Cephalexin;

• Cefixime;

• Ceftriaxone.

The cost of injection ampoules varies from 10 to 50 rubles apiece, and the drug in capsules (Supraks, Ixim, Pancef) will cost you 500-1500 rubles.

Which antibiotic is best for bronchitis?

With this sacramental question, patients most often turn to therapists and pharmacy pharmacists. The answer is unambiguous – the antibiotic that your “culprit” of the disease is sensitive to is best for bronchitis. To determine the pathogen that caused the disease, you need to take an analysis of bronchial mucus for culture.

For a number of reasons, bacterial sputum analysis for bronchitis is very rare:

• Sowing ripens for 5-7 days, and if a patient who is in serious condition is deprived of antibiotic therapy all this time, this may end badly;

• There are fewer and fewer bacteriological laboratories, as well as qualified personnel, therefore, in the conditions of modern free medicine, you are unlikely to be given such an analysis;

• Aminopenicillins are active against almost all possible pathogens of bronchitis, which means that they will help you regardless of which bacterium caused the disease.

Children’s bronchitis: are antibiotics needed?

When a baby gets sick, parents are ready to give any money for medicines, and literally take everything out of the pharmacy that can help him. Seeing the suffering of the child, mothers usually almost demand that the pediatrician prescribe antibacterial drugs, and if he refuses, they run for the pills themselves, fortunately, they are released without a prescription. In fact, this is not a blessing at all, but a real evil.

Treating childhood bronchitis with antibiotics is almost always inappropriate, and here’s why:

• In 99% of cases, bronchitis in children is of a viral nature and is not complicated by a bacterial infection. Strong, young immunity copes with the disease on its own in 1-2 weeks. The only exceptions are premature babies and frequently ill babies under the age of three;

• Even in the presence of a bacterial infection, it is wiser to try to support the child’s immunity, and not to poison his body with antibiotics, on the contrary, reducing defenses and activating other dormant bacteria;

• Whenever a child is treated with antibiotics, he is at increased risk of developing an allergy, and his pathogenic microflora becomes familiar with the drugs and adapts to them. In the future, this may deprive a person of the opportunity to receive help when it is really vital, because he will be allergic to some antibiotics, and pathogens will be insensitive to others.

Everything speaks in favor of getting by with immunostimulants (Imudon) and symptomatic therapy (hot drinks, inhalations, rubbing, mucolytic agents). It is very important to provide the child with peace and proper nutrition during illness (read about this below).

Here is a list of reasons that may prompt a pediatrician to prescribe antibiotics for bronchitis in a small patient:

• Cough does not stop for three weeks or more;

• Sputum acquired a pathological color and smell;

• A blood test shows high leukocytosis and an ESR value above 20 mm / h;

• There are wheezing, shortness of breath, intercostal depression and chest pain;

• Fever is life threatening (temperature above 39 and does not subside);

• There are signs of large-scale intoxication of the body;

• The baby is premature, weakened, under three years old.

Many parents are opposed to the fact that the child was placed in a hospital for treatment, they say, he will pick up more infection there than he will cure. These fears are not unfounded, but still, if the child is very bad, it is better to entrust him to specialists.

List of antibiotics for bronchitis in children

Antimicrobial therapy does not cancel other therapeutic measures, but only complements them. It is still necessary to observe bed rest, drink more fluids, do procedures and take expectorant drugs.

The following groups of antibiotics are used to treat bronchitis in children.:

• Aminopenicillin;

• Cephalosporins;

• Macrolides.

The drugs of choice are Amoxiclav and Augmentin, the merits of which we discussed above. With intolerance to penicillins, cephalosporins will help out: Cefalexin, Ceforuxime, Cefaclor. Treatment of childhood bronchitis with them, especially for a long time, must be accompanied by the intake of live bacterial cultures (Acipol, Bifidumbacterin, Linex, Bifiform) and vitamins C and B.

Macrolides will save you from protracted, chronic and atypical bronchitis (Macrolide, Sumamed, Rulid). These antibiotics are also good because they penetrate well into all body fluids, including bronchial secretions, where they can act on bronchitis pathogens most quickly and effectively.

Modern antibiotics for children are available in an accessible and convenient form: in the form of syrups and fruit-flavored chewable tablets. This greatly facilitates the treatment of bronchitis in young patients.

Treatment of bronchitis with antibiotics during pregnancy

The most unpleasant and dangerous thing that can be imagined during pregnancy is a sudden onset of a serious illness, for the treatment of which drugs may be needed that harm the unborn baby. If a pregnant woman is diagnosed with bronchitis, all measures must be taken to activate her immunity and help to cope with the disease on her own. There are also special immunostimulants that directly protect the fetus and have a local effect, for example, rectal and vaginal suppositories Viferon. They are administered depending on which physiological orifice the placenta is closer to.

If bronchitis cannot be stopped with symptomatic and immunostimulating treatment, it is still wiser to resort to antibiotics than to allow intoxication of the body and high leukocytosis in the expectant mother. These factors will affect the development of the fetus even more negatively than modern antibacterial drugs. Do not forget also that the diaphragm of a pregnant woman is squeezed by a growing fetus, and this significantly complicates the discharge of bronchial mucus and thereby accelerates the reproduction of bacteria in the bronchi.

The tactics of treating bronchitis during pregnancy are as follows:

• In the first trimesterwhen all the main systems and organs of the unborn child are laid, antibiotic treatment is highly undesirable. But if you can’t do without them, the doctor usually prescribes Amoxicillin, Flemoxin, or another drug from the aminopenicillin group.

• In the second and third trimester it is possible to prescribe antibiotics of the cephalosporin series, as well as macrolides;

• It is categorically impossible treat bronchitis in pregnant women with tetracyclines and fluoroquinolones;

10 rules for the treatment of bronchitis with antibiotics

In conclusion, let’s return to the beginning of our conversation and emphasize once again that taking antibiotics for bronchitis is necessary only if it is really necessary. Before prescribing the drug, if not a bacterial culture of sputum, then at least an elementary blood test should be passed. And if leukocytosis is observed, moreover, the number of segmental and stab segments of leukocytes is increased, as well as ESR is more than 20 mm / h, then the treatment of bronchitis with antibiotics is advisable. And if the culprit of bronchitis is an uncomplicated viral infection (as is most often the case), taking antibacterial drugs is pointless and harmful.

1. Write down what antibiotics you have taken before and tell your doctor about it! The same rule applies to children – parents must provide the pediatrician with accurate information about all antibacterial drugs that he was treated with before the first visit to this doctor, and how effective these drugs were, what side effects they caused, whether they were allergic. Objective tolerance data on the frequency of antibiotic use will allow the doctor to choose a drug for the treatment of bronchitis, which is most likely to help the patient and not cause negative consequences.

2. Do not ask your doctor to prescribe antibiotics and do not take them yourself! We are in a hurry to recover as soon as possible, and we think that all the necessary information can be gleaned from drug advertising. Therefore, when a doctor for bronchitis recommends putting mustard plasters and drinking tea with honey, we frown in annoyance and think that this is an unqualified “old school” specialist who is in a hurry to get rid of us as soon as possible. Then we come to the pharmacy, where a helpful pharmacist offers a wide range of modern, cool, strong (and, of course, as expensive as possible) drugs. The result of such treatment is not always a victory over bronchitis, but almost always we get dysbacteriosis, allergies and addiction to antibiotics.

3. Ask for bacteriological sputum analysis if there is no improvement! If after 3-5 days from the beginning of the accurate and timely administration of the antibiotic prescribed to you, there are no positive changes in your state of health, be sure to inform your doctor and ask you to take a sputum test for bacterial culture. Perhaps you have an atypical form of bronchitis, or it is caused by bacteria that are resistant to the selected drug.

4. Strictly observe the dosage, frequency and time of taking antibiotics! If you are prescribed to take medicine three times a day, this does not mean that you need to take a pill during breakfast, lunch and dinner, or before / after a meal. For effective treatment of bronchitis with antibiotics, it is necessary to maintain a constant therapeutic concentration of the drug in the blood. Therefore, if a triple dose is prescribed, this means with breaks of 8 hours, if four times – with breaks of 4 hours, if twice – 12 hours, and if once, then you need to take a pill every day at the same time.

5. Do not stop treatment immediately after feeling better! The duration of treatment of bronchitis with antibiotics depends on the type of drug, and can range from 3 to 14 days, most often 5-7 days. These terms are not taken from the ceiling, but are the results of clinical studies on numerous control groups of patients. “Under-treatment” of infections is even worse than “re-treatment”, that is, unjustified intake of antibiotics. What happens in the body of a patient who interrupts antimicrobial therapy halfway? There remains a colony of bacteria, not completely killed, but only crippled by the antibiotic, and well acquainted with the principle of its action. These pathogens will survive and pass on to their offspring the hereditary genetic information that in the future can lead to a multidrug-resistant, untreatable infection.

6. Avoid interruptions in treatment and inconsistent replacements of the antibiotic! Always purchase as many packs of the drug as you need for a full course of antibiotic treatment of bronchitis. The situation is absolutely unacceptable when at the right time the pills are simply not at hand, and the patient misses taking the medicine, or purchases an analogue of the prescribed drug in the pharmacy, because the necessary pills were not on sale. The analogue may have a different composition or dosage of the active ingredient! In extreme cases, contact your doctor and consult about choosing a replacement.

7. Do not change the dosage! Some people in the treatment of bronchitis with antibiotics observe signs of allergies or severe side effects (nausea, vomiting, diarrhea, weakness, dizziness), but do not say anything to the doctor, but instead stoically endure the torment and simply reduce the dosage of the drug, hoping in this way to reduce the severity unpleasant symptoms. Under no circumstances should this be done! Read about the consequences in paragraph 5. It is also impossible to increase the dosage of antibiotics in order to cure bronchitis as soon as possible, because then there will certainly be side effects and a detrimental effect on the kidneys and liver.

8. Take your antibiotics right! If the instructions say that the medicine should be drunk 20 minutes before a meal, with a meal, or an hour after a meal, then this recommendation should be followed, because each type of antibiotic requires certain conditions for optimal absorption and entry into the blood. There may also be special instructions on how to take the drug (swallow the tablet or capsule whole, chew, dissolve, hold under the tongue), how to drink it (only with water or any other liquid), and how much water is needed for drinking. These recommendations must also be followed, since there are antibiotics that strongly irritate the digestive tract.

9. Do not neglect maintenance therapy! Long-term treatment of bronchitis with antibiotics is almost always accompanied by preventive intake of vitamins, probiotics and fungicides, because without these measures it is difficult to maintain a healthy microflora in the body. A disdainful attitude to the advice of a doctor or a banal desire to save money can result in a long-term indigestion, stomatitis, beriberi, vaginal candidiasis (thrush) and other unpleasant symptoms. Therefore, it is better to purchase and drink all the recommended medicines.

10. Follow a special diet! It is no secret that some types of especially tasty and satisfying foods (smoked meats, fried foods, confectionery) put a heavy burden on the liver. But during the treatment of bronchitis with antibiotics, she has a hard time. There is nothing to talk about alcohol – it not only overloads the kidneys, but also enters into a dangerous interaction with most antibiotics. Try to be as restrained as possible in food during illness, eat more healthy and light foods (cereals, soups, vegetables) and drink at least two liters of clean water per day. Be healthy!