Diagnosis and management of protracted bacterial bronchitis: a survey of Chinese pediatricians

Abstract

Background: Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children.However, it is often misdiagnosed and inappropriately treated in clinical practices. This study aims to investigate the current diagnosis and management of PBB among Chinese pediatricians.Methods: An electronic questionnaire designed to assess the diagnosis and management of PBB was sent to pediatricians in China.Results: A total of 1,022 pediatricians completed the questionnaire. Most (68.8%) of the pediatricians diagnosed PBB in compliance with the guidelines, 44.3% and 24.5% of them followed microbiologybased and clinical-based diagnosis criteria, respectively. Only 40.4% of the pediatricians chose amoxicillinclavulanate as the first-line antibiotic for PBB treatment, 23.7% and 23.5% of them chose third-generation cephalosporins and macrolides, respectively. The majority of pediatricians (75.4%) reported 2-4 weeks of antibiotics course, 19.3% of them prescribed a shorter course and 5% of them selected a longer course.Only 26.3% of the pediatricians performed combined investigations of chest high-resolution computed tomography scan (c-HRCT), bronchoscopy, and immunological tests for recurrences of PBB. Compared with general pediatricians (GP), pediatric pulmonologists (PP) preferred microbiology-based diagnosis criteria, prescribed more amoxicillin-clavulanate, and performed more investigations for recurrent patients (P<0.05). Conclusions:The majority of Chinese pediatricians diagnosed PBB in compliance with guidelines.However, the reasonable antibiotics applications and the investigations for recurrent PBB need to be improved.

Clinical features and pathogen distributions of microbiological-based protracted bacterial bronchitis in children of different ages in Northeast China

“…Macrolides were used in 68.9% of children, and in vitro antibiotic sensitivity testing showed that all bacteria were resistant to macrolides. A survey of 1,022 Chinese pediatricians found that 23.5% chose macrolides as the first-line antibiotic for PBB (9). Although 26 (57.8%) children received cephalosporins before hospitalization, 24 had a course of 5-10 days.…”

“…Although 26 (57.8%) children received cephalosporins before hospitalization, 24 had a course of 5-10 days. Clinicians frequently overlook PBB in the differential diagnosis, particularly general pediatricians (9); as a result, they are more likely to modify the antibiotic therapy than prolong it. The high incidence of wheezing also confounded the diagnosis, particularly in infants.…”

“…Although the global PBB prevalence within the community remains unknown, PBB has been identified as one of the most frequent causes of chronic cough in children in Australia (1,6) and Turkey (7,8), with an incidence ranging from 11% to 41% of all patients presenting for chronic cough. In addition, Chinese clinicians lack PBB diagnosis awareness (9). PBB is mostly diagnosed clinically according to chronic wet cough and response to treatment (3,5).…”

“…In Chinese studies, more than 30% of PBB cases were diagnosed clinically without positive bacterial cultures, leading to misestimation of pathogen distributions (19,21,22). Local pathogen distribution and clinical features of PBB can help clinicians to diagnose and treat PBB (9). However, the PBB's pathogen distribution remains unclear in northeast China.…”

Protracted bacterial bronchitis: new aspects of the problem based on сlinical recommendation of the Ministry of Health of Russian Federation

“…ЗББ включен в зарубежные руководства и учебные пособия по педиатрии, в Австралии и в США диагноз популяризируется СМИ в виде информационных выпусков для родителей [51][52][53]. Продемонстрирована большая осведомленность китайских педиатров о проблеме ЗББ (при опросе 1 022 педиатров 68,8% диагностируют ЗББ согласно руководствам) [54].…”