Does failed chronic wet cough response to antibiotics predict bronchiectasis?

Goyal, Vikas; Grimwood, Keith; Marchant, Julie M.; Masters, Ian Brent; Chang, Anne B.

doi:10.1136/archdischild-2013-304793

Cited by 55 publications

(54 citation statements)

References 31 publications

(34 reference statements)

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“…aureus) found in the lower airways of children with chronic wet or productive cough were associated with increased likelihood of cough resolution [16,48,52]. However, symptomatic recurrences were common [16,48,52], occurring in as many as 76% of cases, while a poor response to ⩾4 weeks of treatment increased the likelihood of the presence of underlying bronchiectasis [47].…”

Section: Therapy (Kq6)mentioning

confidence: 98%

“…Data suggest that children should be referred for further investigations when specific cough pointers (box 2) are present or when the wet cough does not respond to 4 weeks of antibiotics. One study found that failure of the cough to respond to 4 weeks of antibiotics increased the chance of bronchiectasis being present (adjusted OR 20.9, 95% CI 5.4-81.8) [47]. Another study reported that the duration of chronic wet cough was significantly associated with increased risk of structural airway abnormalities and increased Bhalla scores on chest computed tomography (CT) scans [46].…”

Section: Other Causes Of Chronic Wet Cough In Children (Kq2)mentioning

confidence: 99%

“…One was a Cochrane review [64], three were RCTs [30,33,39] and the remaining nine were descriptive studies, of which four involved prospective cohorts of children with a chronic cough [4,8,9,37] and five were retrospective reviews [13,16,47,48,52].…”

Section: Therapy (Kq6)mentioning

confidence: 99%

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ERS statement on protracted bacterial bronchitis in children

et al. 2017

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This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.This article has supplementary material available from

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Section: Therapy (Kq6)mentioning

confidence: 98%

Section: Other Causes Of Chronic Wet Cough In Children (Kq2)mentioning

confidence: 99%

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ERS statement on protracted bacterial bronchitis in children

et al. 2017

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“…Many patients are not well after treatment lasting less than two weeks, or quickly relapse (1,18). Therefore, treatment for 4 -6 weeks used to be recommended (10,19). Our experience tallies with the literature -antibiotic treatment is highly efficacious for some children who become symptom-free after a few days, while others get better gradually over a period of 2 -4 weeks (8).…”

Section: Treatmentmentioning

confidence: 69%

“…When protracted bacterial bronchitis is suspected and antibiotics are ineffective, the child should be assessed for other possible causes (19), and other severe pulmonary disease must also be considered if Pseudomonas aeruginosa develops in the bacterial culture. Further assessment is also recommended in the event of a second recurrence of symptoms (1,2).…”

Section: Differential Diagnosesmentioning

confidence: 99%

Protrahert bakteriell bronkitt hos barn

Øymar¹,

Mikalsen²,

Crowley³

2017

Tidsskriftet

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Protracted bacterial bronchitis: The last decade and the road ahead

et al. 2015

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Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough (>4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1β signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.

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Does failed chronic wet cough response to antibiotics predict bronchiectasis?

Cited by 55 publications

References 31 publications

ERS statement on protracted bacterial bronchitis in children

ERS statement on protracted bacterial bronchitis in children

Protrahert bakteriell bronkitt hos barn

Protracted bacterial bronchitis: The last decade and the road ahead

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