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eMediNexus 16 May 2021
Protracted Bacterial Bronchitis in Children.
Protracted bacterial bronchitis (PBB) is often present with airway malacia in children. It is an often encountered etiology of chronic wet cough in preschool children without any symptoms or signs of other specific causes. It can be usually resolved by a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical and the insulting bacteria may be Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.
The first-line therapy remains Amoxicillin-clavulanate acid for longer than 2 weeks for cough resolution. Even if the wet cough does not improve after prolonged antibiotic treatment, an underlying disease should be considered.
Characteristic of cough and possible diagnosis
Findings associated with cough | Possible diagnosis |
Spontaneously resolving cough, good health | Postinfectious cough |
Wheezing, dry nocturnal cough, atopy, positive familiarity for asthma/allergy | Asthma |
Protracted airway infections, wet cough, positive sputum/BAL culture of a respiratory pathogen | PBB, bronchiectasis |
Recurrent lower airways infections, growth failure, chronic sinusitis, hemoptysis, steatorrhea | Cystic fibrosis |
Persistent wet cough, digital clubbing, exertional dyspnea, chest wall deformity, auscultatory findings | Chronic Suppurative Lung Disease |
Recurrent, severe or atypical Infection | Immunodeficiency (primary or secondary) |
Vomiting, sialorrhea, neurodevelopmental disorders | Gastro Esophageal Reflux Disease–foreign body aspiration |
Stridor, metallic, or biphasic cough | Airway anomalies (tracheomalacia–bronchomalacia) |
Situs inversus, recurrent sinusitis, and/or otitis, recurrent lower airways infections | Primary ciliary dyskinesia |
Source: Front Pediatr. 2020;8:433. Published 2020 Aug 7. doi:10.3389/fped.2020.00433
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