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Cough Update: Protracted Bacterial Bronchitis in Children.

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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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