Acute Bronchitis: How to Care for a Cough and Why Antibiotics Usually Won’t Help

Most people think a bad cough means they need antibiotics. But if you’ve got acute bronchitis, that’s usually not true-and taking them can actually hurt you more than help.

What Exactly Is Acute Bronchitis?

Acute bronchitis is a short-term inflammation of the bronchial tubes-the airways that carry air into your lungs. It’s not pneumonia. It’s not the flu. It’s just your airways getting irritated, usually by a virus.

You’ll know it by the cough. It often starts after a cold or sore throat and can last for weeks. You might cough up clear, white, or yellow mucus. Sometimes you feel a little tired or have a low-grade fever. But if you’re running a high fever, breathing fast, or have chest pain with deep breaths, that’s a red flag for something else-like pneumonia.

It’s super common. About 5% of adults get it every year in the U.S., and it’s one of the top 10 reasons people visit the doctor. The cough alone lasts an average of 18 days. Half of people are still coughing at 10 days. One in four still has it at two weeks. And 1 in 10 are coughing at three weeks. That’s normal. It doesn’t mean you’re getting worse. It just means your airways are healing slowly.

Why Antibiotics Don’t Work for Most Cases

Ninety to ninety-five percent of acute bronchitis cases are caused by viruses-rhinovirus, coronavirus, flu, RSV. Antibiotics kill bacteria. They do nothing to viruses.

Despite that, doctors still prescribe antibiotics for acute bronchitis way too often. In 2022, over half of all visits for bronchitis ended with an antibiotic prescription. That’s down from 74% in 2010, but it’s still far too high.

Why? Because patients expect them. And doctors feel pressured to give something, even if it’s not helpful. But here’s the truth: antibiotics reduce cough duration by less than a day-just 0.6 days on average. That’s not worth the risk.

Every time you take an antibiotic unnecessarily, you increase your chances of side effects. About 1 in 14 people get diarrhea, nausea, or a rash. Some get serious allergic reactions. And on a larger scale, overuse leads to antibiotic resistance. That’s when bacteria evolve to survive drugs, making infections harder to treat. The CDC says 46 million unnecessary antibiotic prescriptions are given each year for respiratory infections like bronchitis. That fuels 2.8 million resistant infections and 35,000 deaths annually in the U.S. alone.

What Actually Helps a Cough from Bronchitis

Since antibiotics don’t work, what does? The answer is simple: time and smart symptom care.

• Rest. Your body needs energy to fight the virus. Skip the gym, skip the late nights, and let yourself sleep.
• Hydrate. Drink 8 to 10 glasses of water a day. Fluids thin mucus so it’s easier to cough up. Warm tea, broth, or even just plain water helps.
• Humidify. Use a cool-mist humidifier in your room. Or sit in a steamy bathroom for 10 minutes. Moist air soothes irritated airways.
• Use pain relievers. If you have a sore throat or body aches, take ibuprofen (Advil) or acetaminophen (Tylenol). Stick to the label-no more than 3,000 mg of acetaminophen a day if you don’t have liver problems.

What About Cough Medicines?

Over-the-counter cough syrups? They’re a mixed bag.

Honey is one of the best options-especially for nighttime coughs. Studies show it works as well as dextromethorphan (the active ingredient in many cough syrups) and better than nothing. For adults, take 1 to 2 tablespoons as needed. Important: Never give honey to babies under 1 year old. It can cause botulism.

Dextromethorphan (found in Robitussin DM, Delsym) can help reduce cough frequency. It’s not magic, but it might make sleep easier. The standard dose is 15-30 mg every 6-8 hours, max 120 mg per day. Avoid it if you’re on antidepressants or have liver disease.

Guaifenesin (Mucinex) is supposed to loosen mucus. But studies are all over the place. Some show a tiny benefit. Others show nothing. It’s not harmful, but don’t expect miracles.

Inhalers like albuterol? Only help if you’re wheezing. About 1 in 3 people with bronchitis have mild wheezing. If you don’t wheeze, these won’t help-and they can cause shaky hands, fast heartbeat, or anxiety.

Codeine and opioid cough syrups? Avoid them. The FDA banned codeine for kids under 12 in 2018 because of breathing risks. Even for adults, they’re rarely needed and carry addiction risks.

When Should You See a Doctor?

You don’t need to go for every cough. But here are the red flags:

• Fever above 38°C (100.4°F) that lasts more than a few days
• Shortness of breath or wheezing that gets worse
• Coughing up blood
• Chest pain when you breathe or cough
• Cough lasting longer than 3 weeks with no improvement
• Weight loss, night sweats, or extreme fatigue

If you have asthma, COPD, or a weak immune system, talk to your doctor sooner. You’re at higher risk for complications.

Why Doctors Still Prescribe Antibiotics

It’s not because they don’t know better. They do. The guidelines from the American Academy of Family Physicians, the CDC, and the American College of Chest Physicians have been clear since 2006: don’t prescribe antibiotics for acute bronchitis.

But patient pressure is real. People walk in saying, “I need something strong.” They’ve had antibiotics before. They believe they work. So doctors give them-sometimes with a delayed script. That means: “Take this if you’re not better in 48 hours.”

That strategy works. Studies show it cuts antibiotic use by half without making patients sicker. It gives time for the virus to run its course, and only uses antibiotics if something bacterial shows up.

Doctors are also getting better at explaining the timeline. Saying, “Your cough might last 2 to 3 weeks, and that’s normal,” reduces anxiety. Most people just need to know it’s not dangerous.

The Bigger Picture: Antibiotic Resistance

This isn’t just about your cough. It’s about the future of medicine.

Every time you take an antibiotic when you don’t need it, you’re helping superbugs survive. These are bacteria that no longer respond to common drugs. MRSA. Drug-resistant pneumonia. Untreatable UTIs. They’re already killing 35,000 Americans every year.

Acute bronchitis is one of the biggest drivers of this problem. The Choosing Wisely campaign-backed by top medical groups-lists “Don’t prescribe antibiotics for acute bronchitis” as a top priority for doctors.

There’s progress. Antibiotic prescribing for bronchitis has dropped from 74% in 2010 to 51% in 2022. But it’s still too high. The goal? Get it below 20% by 2026.

That’s not just a number. It’s a public health win. Fewer side effects. Fewer resistant infections. Lower healthcare costs. The CDC estimates that cutting unnecessary prescriptions for bronchitis by half could save $150 million a year and prevent 20,000 adverse events.

What You Can Do Right Now

1. Don’t ask for antibiotics. If your doctor offers one, ask: “Is this caused by a virus? Will antibiotics help?”

2. Use honey for coughs. It’s natural, safe for adults, and works better than most OTC syrups.

3. Wait it out. If you’re otherwise healthy, your body will clear this on its own. Coughing for two weeks isn’t a failure-it’s healing.

4. Protect others. Wash your hands. Cover your cough. Stay home if you’re feverish. You’re contagious in the first few days.

5. Know your limits. If you’re over 65, have lung disease, or your symptoms worsen after 10 days, call your doctor. But don’t rush to the clinic for a cough that’s just stubborn.

Acute bronchitis isn’t serious for most people. But it’s a test of our medical habits. Do we trust our bodies to heal? Or do we reach for a pill every time we feel uncomfortable? The answer matters-for you, and for everyone who might need antibiotics someday.