what is the evidence-based treatment for infectious tracheobronchitis and when are antibiotics warranted?

Question

Accepted Answer

The veterinary literature does not contain controlled trials establishing an evidence-based treatment protocol for infectious tracheobronchitis (kennel cough); no evidence exists for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce clinical duration. 1 Antibiotics are not routinely warranted in stable dogs with infectious tracheobronchitis. Bacterial infection has not been identified on histologic examination in dogs with tracheobronchial disease, and routine antibiotic use is contrary to published guidelines. 2 When culture results do support a true bacterial infection, antibiotic selection should be guided by the site of infection and the blood-bronchus barrier — penicillins penetrate respiratory secretions poorly and are not appropriate empiric choices for tracheobronchitis. 2 In cats, antibiotic treatment is indicated when tracheobronchial culture is positive for a true bacterial pathogen or Mycoplasma; doxycycline, azithromycin, and fluoroquinolones are effective against Mycoplasma infections. 3 When antibiotics are used in dogs, selection should account for likely pathogens. Mycoplasma spp. are resistant to all penicillins, so penicillin-class drugs are inappropriate when Mycoplasma is a concern. 2 Culture rates in dogs with tracheobronchial disease vary widely — positive culture rates range from as low as 10% to as high as 83% across published reports — underscoring that empiric antibiotic use without culture data is difficult to justify. 2 The evidence base for this condition has a critical gap. The contribution of bacterial infection to the pathogenesis and progression of canine tracheobronchial disease remains unresolved, and antibiotic stewardship in this population is an identified area for improvement. 2 --- Would you like guidance on which specific antibiotic classes are recommended when culture confirms a bacterial pathogen in canine tracheobronchitis?