What are the current guidelines for the use of antibiotics in acute bronchitis?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For the management of acute bronchitis, antibiotics are not routinely offered, as symptomatic treatments are considered the mainstay . The decision to prescribe antibiotics is guided by clinical assessment and, if available, C-reactive protein (CRP) test results ,.

  • CRP-Guided Prescribing:
    • If the CRP level is less than 20 mg/L, antibiotics should not be routinely offered ,.
    • If the CRP level is between 20 mg/L and 100 mg/L, a delayed (back-up) antibiotic prescription may be considered ,. A back-up prescription is for use at a later date if symptoms worsen .
    • If the CRP level is greater than 100 mg/L, antibiotic therapy should be offered ,.
  • Immediate Antibiotic Prescription:
    • An immediate antibiotic prescription should be offered if the person is systemically very unwell .
    • An immediate or back-up antibiotic prescription can be considered if the person is at higher risk of complications, such as having a pre-existing comorbidity or being of older age and fulfilling certain criteria .
  • Antibiotic Choices and Duration (5-day course):
    • For adults aged 18 years and older:
      • The first-line choice is oral doxycycline: 200 mg on the first day, then 100 mg once a day for 4 days (5-day course in total) . Doxycycline is not the first-choice antibiotic for pregnant women .
      • Alternative first choices are oral amoxicillin (500 mg three times a day for 5 days, preferred in pregnant women), clarithromycin (250 mg to 500 mg twice a day for 5 days), or erythromycin (250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days, preferred in pregnant women) .
    • For young people aged 12–17 years:
      • The first-line choice is oral amoxicillin: 500 mg three times a day for 5 days (preferred in young women who are pregnant) .
      • Alternative first choices are oral clarithromycin (250 mg to 500 mg twice a day for 5 days), erythromycin (250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days, preferred in young women who are pregnant), or doxycycline (200 mg on the first day, then 100 mg once a day for 4 days, 5-day course in total) . Doxycycline should not be given to young women who are pregnant .
  • Treatments Not Routinely Offered:
    • Do not offer an oral or inhaled bronchodilator (e.g., salbutamol) or an oral or inhaled corticosteroid unless the person has an underlying airway disease such as asthma .
    • Do not offer a mucolytic (e.g., acetylcysteine or carbocisteine) to treat an acute cough associated with acute bronchitis .
    • Do not offer rapid point-of-care microbiological tests or influenza tests to determine whether to prescribe antimicrobials .
  • Self-Care and Safety-Netting:
    • Offer written advice, such as NHS information on Chest infection .
    • Promoting self-care may help reduce antibiotic prescriptions and general practice consultations .
    • Safety-netting advice is important to ensure medical help is sought appropriately, especially when a back-up prescription is given .

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