Over-the-counter guide to acute viral bronchitis with supportive care, including hydration, rest, and pain relievers like acetaminophen or ibuprofen for discomfort. For cough relief, consider dextromethorphan (30 mg) or guaifenesin (600–1200 mg every 12 hours). In children, honey can reduce cough severity and improve sleep but should not be given to infants under one year. Antibiotics are rarely needed unless bacterial superinfection is confirmed.
January 9, 2025

Acute Bronchitis: Best OTC Treatments

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Acute bronchitis is inflammation of the bronchial tubes typically caused by common respiratory viruses. It is self-limited, resolving within 1-2 weeks and management is supportive. After 2 weeks without improvement, please see a doctor to inquire about antibiotic management.

For people without known immune system issues, the American College of Chest Physicians official 2020 recommendations are not to routinely prescribe antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, or oral NSAIDs for bronchitis lasting less than 3 weeks.

Recommendations for symptom relief without medication:

  • Hydration and rest: Drink plenty of fluids and rest to support recovery.

  • Steam inhalation: Observational evidence and at least one clinical trial show that using a Personal Steam Inhaler may lead to modest reduction in symptom severity.

Symptom relief over-the-counter best options:

  • Pain relievers if needed: Dose: Acetaminophen 500mg tablets (FDA M017): 500-1000 mg every 6 hours as needed (max 3000 mg/day). Ibuprofen 200mg softgels (FDA N021472): 200-400 mg every 4-6 hours as needed (max 1200 mg/day).

  • Dextromethorphan: Three placebo-controlled trials show that dextromethorphan, 30 mg, decreases cough count by 19% to 36%. Guaifenesin/Dextromethorphan 600 mg/30 mg combo (FDA M012).

  • Guaifenesin: At least three trials of guaifenesin vs. placebo showed some benefit in most patients. Adults and children ≥ 12 years of age: guaifenesin extended release 600-1200 mg PO every 12 hours as needed (max. 2400 mg/day). Guaifenesin 600 mg Tablets (FDA M012).

Pediatric symptom relief:

  • Honey: In children under 12, anti-cough medication may have serious side effects. Honey has been shown to be better than no treatment in decreasing the frequency and severity of cough, decreasing bothersome cough, and improving quality of sleep. Honey should not be given to children under 1 year of age. Pure honey 12oz.

Prescription medications:

  • Antibiotics for bacterial superinfection: Rarely required.  Avoid antibiotics unless bacterial infection is confirmed. Most cases resolve in 1-3 weeks.

  • Bronchodilators (e.g., albuterol inhaler): For significant wheezing or shortness of breath.

Citation:

Kinkade, S., & Long, N. A. (2016). Acute bronchitis. American family physician, 94(7), 560-565.

Smith, M. P., Lown, M., Singh, S., Ireland, B., Hill, A. T., Linder, J. A., Irwin, R. S., & CHEST Expert Cough Panel (2020). Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report. Chest, 157(5), 1256–1265. https://doi.org/10.1016/j.chest.2020.01.044

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

Where do I view other OTC guides?

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You can view all of our published OTC guides here.

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