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An 18-year-old woman presents to the clinic complaining of a dry cough lasting for 2 weeks. She is afebrile and reports no shortness of breath. The patient, who does not have a remarkable past medical history, is diagnosed with acute bronchitis. Which of the following is the best therapy?
Acute bronchitis is a clinical diagnosis and is described as an acute cough, with or without sputum production, due to inflammation of the trachea and large airways of the lungs, without evidence of a lower respiratory infection or a chronic lung disease. The cough associated with acute bronchitis usually lasts for 2–3 weeks. Although fever can occur during the first few days of symptoms, the presence of prolonged fever or a temperature above 100.0°F is not typical and raises the possibility of pneumonia or influenza. The presence of sputum, even if purulent, does not correlate with bacterial infection and is insufficient to warrant antimicrobial treatment. Acute bronchitis is most commonly caused by a virus, such as rhinovirus, enterovirus, or respiratory syncytial virus. Symptomatic treatment and supportive care are recommended, such as by the use of dextromethorphan, guaifenesin, or honey. Dextromethorphan is a nonopioid antitussive shown to be effective at decreasing cough symptoms, and guaifenesin is an expectorant with some benefit in decreasing cough frequency and intensity. The combination of dextromethorphan with guaifenesin is beneficial for the management of acute bronchitis.
Antibiotics such as azithromycin (A) are not recommended in most patients with acute bronchitis. Antibiotics are still commonly prescribed, even though up to 90% of acute bronchitis cases are due to a virus. Antibiotics are only indicated if the patient is suspected of having pertussis (which may be treated with a macrolide) or another contagious illness or if the patient is at increased risk of complications. Codeine (B) is an opioid antitussive given to reduce the cough reflex. However, the American College of Chest Physicians does not recommend the use of codeine in the treatment of upper respiratory infections. Beta-2 agonists such as salbutamol (D) are not recommended for the routine treatment of acute bronchitis due to lack of benefit unless wheezing or airway obstruction is present or there is any underlying lung disease.
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