When should I consider prescribing antibiotics for a patient with acute bronchitis?

For a patient presenting with acute bronchitis, antibiotic prescribing should be considered based on their clinical presentation and, if performed, C-reactive protein (CRP) levels ¹,⁴.

Immediate Antibiotic Prescription:

• Offer an immediate antibiotic prescription if the person is systemically very unwell on face-to-face examination ¹,³.
• Consider an immediate antibiotic prescription 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 ¹,³.
• If a point-of-care CRP test has been carried out for a lower respiratory tract infection and the CRP level is greater than 100 mg/L, offer immediate antibiotics ¹,⁴.

Delayed (Back-up) Antibiotic Prescription:

• Consider a back-up antibiotic prescription if the person is at higher risk of complications ¹,³. This involves giving advice that the antibiotic is not needed immediately and should be used if symptoms worsen rapidly or significantly at any time ³. Safety-netting advice should be provided ¹.
• If a point-of-care CRP test has been carried out and the CRP level is between 20 mg/L and 100 mg/L, consider a delayed antibiotic prescription ¹,⁴.

Do Not Routinely Offer Antibiotics:

• Do not routinely offer antibiotics if a CRP test has been carried out and the CRP level is less than 20 mg/L ¹,⁴.
• Do not issue an immediate prescription for an antimicrobial to a patient who is likely to have a self-limiting condition ⁵. Acute bronchitis is largely managed with symptomatic treatments ¹.
• Do not offer an oral or inhaled bronchodilator, oral or inhaled corticosteroid, or a mucolytic to a person with an acute cough associated with acute bronchitis unless they have an underlying airway disease such as asthma ¹.