Bacterial bronchitis
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Summary
10 papers analyzed
These studies suggest that protracted bacterial bronchitis in children is a common condition often associated with chronic cough, certain bacterial infections, and is effectively treated with antibiotics like amoxicillin/clavulanic acid.
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Protracted Bacterial Bronchitis in Children: An Overview
Definition and Clinical Features of Protracted Bacterial Bronchitis
Protracted bacterial bronchitis (PBB) is a significant cause of chronic cough in children, characterized by a persistent wet cough lasting at least four weeks, which resolves following a course of appropriate antibiotics . The condition is often seen in children under six years of age and is associated with symptoms such as wheezing and airway malacia . The diagnosis is typically clinical, based on the presence of a chronic moist cough and the absence of other specific causes of cough .
Microbiology and Pathogenesis
The most common pathogens implicated in PBB are nontypable Haemophilus influenzae and Streptococcus pneumoniae . Moraxella catarrhalis is also frequently identified, particularly in children with a history of chronic cough . These bacteria colonize the bronchial mucous membranes, leading to neutrophil infiltration and chronic inflammation. The role of bacterial load and species in modulating airway inflammation has been highlighted, with higher bacterial loads correlating with increased markers of inflammation.
Risk Factors and Epidemiology
Several risk factors have been identified for the development of PBB. These include childcare attendance, a prior history of chronic cough, and younger age, particularly under two years. Interestingly, baseline diagnoses of asthma or bronchiolitis appear to decrease the risk of developing PBB. The prevalence of PBB varies, with studies indicating it as a common cause of chronic cough in preschool-aged children .
Impact of Vaccination
Vaccination, particularly with pneumococcal-conjugate vaccines (PCV-7 and PCV-13), has influenced the microbiological landscape of PBB. Studies have shown that vaccination can lead to serotype replacement, with non-vaccine serotypes of Streptococcus pneumoniae becoming more prevalent in vaccinated populations. This highlights the need for ongoing surveillance and possibly the development of new vaccines to cover a broader range of serotypes.
Treatment Strategies
The mainstay of treatment for PBB is a prolonged course of antibiotics, typically for two to four weeks, with amoxicillin/clavulanic acid being the first-line choice . The effectiveness of antibiotics in resolving symptoms and preventing complications such as bronchiectasis has been well-documented . However, the optimal duration of therapy remains a subject of debate, with some guidelines suggesting extending treatment up to six weeks in cases of relapse or persistent symptoms.
Future Research Directions
Despite advances in understanding PBB, several areas require further research. These include better identification of the disease burden, understanding the natural history and underlying mechanisms, and optimizing treatment strategies through randomized controlled trials. Additionally, there is a need for more prospective data to inform clinical practice and improve outcomes for children with PBB.
Conclusion
Protracted bacterial bronchitis is a common and treatable cause of chronic cough in children. Early recognition and appropriate antibiotic therapy are crucial in managing this condition and preventing complications. Ongoing research and surveillance are essential to address the evolving microbiological landscape and optimize treatment protocols.
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