Acute Bronchitis: How to Care for a Cough and Why Antibiotics Usually Don’t Work

Most people think a bad cough means they need antibiotics. But if you’ve been coughing for more than a few days with no fever, no trouble breathing, and no chest pain, you probably have acute bronchitis - and antibiotics won’t help. In fact, they might make things worse.

What Exactly Is Acute Bronchitis?

Acute bronchitis is an inflammation of the bronchial tubes - the airways that carry air to your lungs. It’s not pneumonia. It’s not a cold. It’s a viral infection that starts in your upper respiratory tract and moves down, irritating the lining of your airways. The result? A cough that can last for weeks.

It’s one of the most common reasons people visit their doctor. In the U.S., about 10 million visits each year are for acute bronchitis. Most of the time, it’s caused by viruses - rhinovirus (the common cold), flu, coronavirus, or RSV. Bacteria? Rare. Less than 10% of cases.

The cough is the main symptom. It might start dry, then turn wet with clear or white mucus. You might feel tired, have a mild sore throat, or feel a bit achy. But if you have a fever over 38°C, rapid breathing, or chest pain that gets worse when you breathe, that’s not bronchitis - that’s pneumonia. See a doctor right away.

How Long Does the Cough Last?

This is where most people get frustrated. You expect to feel better in a few days. But with acute bronchitis, the cough lingers.

Studies show:

50% of people are still coughing at 10 days
26% are coughing at 14 days
11% are coughing at 21 days

That’s not normal for a cold. But it’s normal for bronchitis. Your airways are healing slowly. The inflammation doesn’t vanish overnight. If you’re still coughing after three weeks, it’s time to check in with your doctor - but don’t assume it’s bacterial. It’s often just lingering irritation.

Why Antibiotics Don’t Work (and Why They’re Dangerous)

Antibiotics kill bacteria. They don’t touch viruses. And since 90-95% of acute bronchitis cases are viral, antibiotics are useless here.

But here’s the scary part: even though doctors know this, they still prescribe antibiotics in more than half of cases. In some parts of the U.S., the rate hits 78%. Why? Because patients ask for them. Because doctors feel pressured. Because it’s easier than explaining why you don’t need them.

The truth? Antibiotics give you almost no benefit. A major review of nine studies with over 5,600 patients found antibiotics reduce cough duration by just 0.6 days. That’s less than half a day. Meanwhile, 1 in 14 people gets side effects - nausea, diarrhea, rash, or yeast infections.

And that’s just the personal cost. The bigger problem is antibiotic resistance. Every unnecessary antibiotic you take helps superbugs grow. The CDC says respiratory infections like bronchitis drive 46 million unnecessary antibiotic prescriptions in the U.S. each year. That’s part of why 2.8 million people get antibiotic-resistant infections annually - and 35,000 die.

A doctor and patient share a calm moment in a clinic, with a delayed antibiotic prescription and a fading virus symbol.

What Actually Helps? Evidence-Based Cough Care

You don’t need antibiotics. But you do need relief. Here’s what works - backed by science:

1. Honey

Honey is one of the best cough remedies you already have in your kitchen. A 2018 study in JAMA Pediatrics found honey worked as well as over-the-counter cough medicine in kids - and better than nothing. For adults, 1 to 2 teaspoons (5-10 mL) before bed can quiet a nighttime cough.

Important: Never give honey to children under 1 year old. It can cause botulism - a rare but dangerous illness.

2. Dextromethorphan (DM)

This is the active ingredient in many OTC cough syrups like Robitussin DM. It doesn’t cure bronchitis, but it can slightly reduce cough frequency. A 2014 Cochrane review showed it lowers coughing by a small but measurable amount. Take 15-30 mg every 6-8 hours, not more than 120 mg in 24 hours.

3. Fluids and Humidifiers

Drink plenty of water - at least 8-10 glasses a day. It thins mucus so it’s easier to clear. Use a cool-mist humidifier in your bedroom. Breathing moist air soothes irritated airways. You can also lean over a bowl of hot water with a towel over your head - just be careful not to burn yourself.

4. Pain and Fever Relief

If you have a low-grade fever or body aches, use acetaminophen (Tylenol) or ibuprofen (Advil). Stick to the label. Don’t exceed 3,000 mg of acetaminophen a day if you have liver issues. Ibuprofen can irritate your stomach, so take it with food.

5. Avoid Inhaled Bronchodilators - Unless You Wheeze

Some people think inhalers like albuterol help with bronchitis cough. They don’t - unless you’re wheezing. Studies show no benefit for non-wheezers. And if you use them unnecessarily, you risk tremors, rapid heartbeat, or anxiety. If you’re wheezing, talk to your doctor - you might have asthma or bronchospasm.

6. Skip Guaifenesin (Mucinex)

This expectorant is supposed to loosen mucus. But the evidence is weak. Out of seven studies, only two showed any real benefit. It’s not harmful, but don’t expect miracles.

What to Say to Your Doctor

If you go in with a cough, your doctor should be able to tell if it’s bronchitis without an X-ray or lab test. But if you feel pressured to get antibiotics, here’s what to say:

“I’ve had this cough for 10 days with no fever. I’ve read that antibiotics usually don’t help with bronchitis. Can we talk about what else might help?”
“I know coughs can last weeks. I just want to make sure it’s not something else.”
“I’d rather avoid antibiotics unless they’re really needed.”

Many doctors now use “delayed prescriptions.” They give you a prescription for antibiotics - but tell you to fill it only if you haven’t improved after 48-72 hours. This reduces unnecessary use without making patients feel ignored.

A symbolic scene shows antibiotics dissolving while healing elements like honey, steam, and light restore a lung.

When to Worry - Red Flags

Most cases of acute bronchitis clear up on their own. But call your doctor if you have:

Fever over 38°C (100.4°F)
Shortness of breath or wheezing that gets worse
Coughing up blood
Cough lasting more than 3 weeks
Weight loss, night sweats, or fatigue that doesn’t go away

These could signal pneumonia, asthma, COPD, or even tuberculosis - especially if you smoke or have a weak immune system.

Why This Matters Beyond Your Cough

Choosing not to take antibiotics for bronchitis isn’t just about you. It’s about protecting everyone. Antibiotic resistance isn’t a future threat - it’s happening now. Superbugs are spreading in hospitals, homes, and communities. Every time we use antibiotics when we don’t need them, we make it harder to treat infections like sepsis, pneumonia, or even a simple cut that turns infected.

The Choosing Wisely campaign, backed by medical societies across the U.S., says clearly: “Don’t prescribe antibiotics for acute bronchitis.” And the CDC, the American Academy of Family Physicians, and the American College of Chest Physicians all agree.

The goal isn’t to make you suffer. It’s to help you heal - safely, effectively, and without adding to a growing public health crisis.

What’s Coming Next?

Researchers are looking for better ways to tell viral from bacterial bronchitis. Right now, it’s mostly guesswork based on symptoms. But new studies - like the NIH-funded BREATHE trial - are testing natural remedies like ivy leaf extract. Early results are promising.

The American Academy of Family Physicians also wants to cut inappropriate antibiotic prescribing for bronchitis to under 20% by 2026. That means better education, better tools, and better conversations between patients and doctors.

Until then, the best thing you can do is rest, hydrate, use honey or dextromethorphan if needed, and resist the urge to reach for antibiotics. Your cough will fade. Your lungs will heal. And you’ll help save antibiotics for when they truly matter.

Is acute bronchitis contagious?

Yes, the viruses that cause acute bronchitis are contagious - usually spread through coughs and sneezes. But once you’re sick, you’re not spreading the bronchitis itself. You’re spreading the virus. That’s why handwashing and covering your mouth when you cough matter. Most people stop being contagious after a few days, even if the cough lasts longer.

Can I get bronchitis more than once a year?

Yes. People who smoke, have asthma, or are frequently exposed to irritants like smoke or pollution are more likely to get bronchitis repeatedly. If you’ve had three or more episodes in a year, talk to your doctor. You might have a chronic condition like asthma or early COPD.

Does smoking make bronchitis worse?

Absolutely. Smoking damages your airways and slows healing. If you smoke and get bronchitis, your cough will last longer, you’ll be more likely to get it again, and your risk of developing chronic bronchitis or COPD increases dramatically. Quitting is the best thing you can do for your lungs - even after you’ve had bronchitis.

Should I use a cough suppressant or an expectorant?

It depends on your cough. If your cough is dry and keeps you awake, try a suppressant like dextromethorphan. If you’re coughing up thick mucus and feel like you can’t clear your chest, an expectorant like guaifenesin might help - but don’t expect it to work miracles. Honey often works better than either for nighttime coughs.

Can children get acute bronchitis?

Yes, but it’s less common in healthy children than in adults. When kids get it, the same rules apply: no antibiotics unless there’s clear evidence of bacteria. Honey is safe for kids over 1 year old and often works better than OTC cough syrups. Never give children under 4 any over-the-counter cough or cold medicine - it’s risky and often ineffective.