Last updated March 14, 2022

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis

Recommendations

1. For children aged ≤14 years with chronic (>4 weeks’ duration) wet or productive cough unrelated to an underlying disease and without any specific cough pointers (eg, coughing with feeding, digital clubbing), we recommend that children receive 2 weeks of antibiotics targeted to common respiratory bacteria (Streptococcus pneumoniaeHaemophilus influenzae, Moraxella catarrhalis) and local antibiotic sensitivities. (1A)
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2. For children aged ≤14 years with chronic wet or productive cough unrelated to an underlying disease and without any specific cough pointers (eg, coughing with feeding, digital clubbing) and whose cough resolves within 2 weeks of treatment with antibiotics targeted to local antibiotic sensitivities, we recommend that the diagnosis of protracted bacterial bronchitis (PBB) be made. (1C)
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3. For children aged ≤14 years with PBB with lower airway (bronchoalveolar lavage or sputum) confirmation of clinically important density of respiratory bacteria (≥ 104 cfu/ml), we recommend that the term ‘microbiologically-based-PBB’ (or PBB-micro) be used to differentiate it from clinically-based-PBB (PBB without lower airway bacteria confirmation) . (1C)
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4. For children aged ≤14 years with chronic wet or productive cough unrelated to an underlying disease and without any specific cough pointers (eg, coughing with feeding, digital clubbing) when the wet cough persists after 2 weeks of appropriate antibiotics, we recommend treatment with an additional 2 weeks of the appropriate antibiotic(s). (1C)
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5. For children aged ≤14 years with chronic wet or productive cough unrelated to an underlying disease and without any specific cough pointers (eg, coughing with feeding, digital clubbing), when the wet cough persists after 4 weeks of appropriate antibiotics, we suggest that further investigations (eg, flexible bronchoscopy with quantitative cultures and sensitivities with or without chest computed tomography) be undertaken. (2B)
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6. For children aged ≤14 years with chronic wet or productive cough unrelated to an underlying disease and with specific cough pointers (eg, coughing with feeding, digital clubbing), we recommend that further investigations (eg, flexible bronchoscopy and/or chest computed tomography, assessment for aspiration and/or evaluation of immunologic competency) be undertaken to assess for an underlying disease. (1B)
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7. For children aged ≤14 years with chronic wet or productive cough unrelated to an underlying disease and without any specific cough pointers (eg, coughing with feeding, digital clubbing), we suggest that randomized controlled trials on the efficacy of different durations of antibiotics be undertaken in various clinical settings (particularly in primary care) to determine its influence on the number to treat and recurrence. When doing so, we suggest that validated cough outcomes and a-priori definitions be used. (U-CBS)
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Recommendation Grading

Overview

Title

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis

Authoring Organization

Publication Month/Year

April 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations?

Target Patient Population

Children with chronic wet cough

Inclusion Criteria

Female, Male, Child

Health Care Settings

Ambulatory, Childcare center, Hospital, Outpatient, School

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D010372 - Pediatrics, D003371 - Cough, D001991 - Bronchitis, D029481 - Bronchitis, Chronic

Keywords

children, pediatric, bronchitis, bacterial, cough, chronic cough