Amoxycillin-clavulanate for chronic wet cough in children: cautious interpretation of study findings warranted

Stark, Patrick; Heenan, Rachel; Orsani, Francesca; Jachno, Kim; Connell, Tom

doi:10.1136/thoraxjnl-2012-202885

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…The score used to calculate self-rated improvement in cough may not be appropriate for the young children in the study population. 32 Furthermore, prior diagnostic evaluations and therapies for the children were not described. Lastly, differences in referral patterns to pediatric pulmonologists may result in selection bias for enrolled patients, particularly in a small study.…”

Section: Featurementioning

confidence: 99%

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Bidiwala¹,

Krilov²,

Pirzada³

et al. 2015

Pediatr Ann

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Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterial infection of conducting airways defined by the presence of cough for longer than 4 weeks that resolves with antimicrobial therapy and without an alternative diagnosis. The diagnosis is made by the findings of increased bronchial secretions and edema of the lower airways on flexible bronchoscopy and positive cultures on bronchoalveolar lavage. It is speculated that an initial respiratory insult such as viral infection disrupts normal surface morphology and ciliary function, which leads to chronic self-perpetuating inflammation with the formation of bacterial biofilms, leading to PBB. PBB is often misdiagnosed as asthma, leading to inappropriate and excessive use of steroids. The importance of timely diagnosis should be emphasized due to the potential that PBB may be a precursor to chronic suppurative lung disease or bronchiectasis if left untreated; however, every patient should be adequately assessed to exclude other causes of chronic cough.Con: Clinical criteria for the diagnosis of PBB are nonspecific and may not distinguish it from other known causes of chronic cough, including viral infections. Benefits from antibiotic therapy (particularly prolonged therapy) have not been demonstrated. Respiratory conditions are the most common reason for antibiotic prescriptions during ambulatory visits in the United States, and many of these prescriptions are inappropriate and/or unnecessary. The proposed diagnostic criteria and recommendations for the treatment of PBB will lead to unnecessary overuse of antibiotics.

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Section: Featurementioning

confidence: 99%

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Bidiwala¹,

Krilov²,

Pirzada³

et al. 2015

Pediatr Ann

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“…The evidence-base for benefits of antibiotic therapy in children with PBB mainly rely on a single randomized controlled study (RCT) involving children with chronic cough in Australia (15). Substantial concerns regarding the study methodology have been raised; chronic cough was defined as 3 rather than 4 weeks duration (but most children were coughing for far longer), prior therapies were not described, and the number of patients was small (16). Half of the patients were still coughing and 25% who received placebo were cough-free after 2 weeks; however, most patients who did not have clinical resolution had comorbidities (15).…”

Section: Protracted Bacterial Bronchitismentioning

confidence: 99%

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

Benedictis

Carloni²,

Comberiati

et al. 2019

Front. Pediatr.

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The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.

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Chronic Cough

Milgrom¹

2016

Pediatric Allergy: Principles and Practice

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Amoxycillin-clavulanate for chronic wet cough in children: cautious interpretation of study findings warranted

Cited by 3 publications

References 3 publications

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

Chronic Cough

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