CHEST Guidelines-Management-of-Children-With-Chronic-Wet-Cough-and- (2)

Management-of-Children-With-Chronic-Wet-Cough-and- (2)

Pdf Summary

The CHEST Guideline and Expert Panel Report focuses on the management of children under 14 years with chronic wet cough, also addressing Protracted Bacterial Bronchitis (PBB). Recommendations are based on systematic reviews that consider antibiotics' efficacy and the necessity for further investigations. Key findings include:

1. <strong>Antibiotic Efficacy</strong>: High-quality evidence shows that antibiotics significantly improve cough resolution in children with chronic wet cough lasting more than four weeks. A two-week course of antibiotics targeting common respiratory bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis is recommended if no specific cough pointers (like digital clubbing) are present.

2. <strong>Diagnosis of PBB</strong>: If the cough resolves with antibiotics, it may indicate PBB. For cases where lower airway bacteria density is confirmed, the term "microbiologically-based-PBB" (PBB-micro) is recommended.

3. <strong>Investigations</strong>: If cough persists after antibiotic therapy or if specific symptoms are present, further investigations like flexible bronchoscopy or chest CT scans should be considered to rule out underlying diseases, such as bronchiectasis.

4. <strong>Research Needs</strong>: There is limited evidence from primary care settings. Future research should include randomized controlled trials assessing antibiotic duration efficacy and the role of different management strategies across various clinical environments.

Compared to previous 2006 guidelines, this report underscores the increased recognition of PBB as a distinct clinical entity and emphasizes the need for continued research, especially in primary healthcare, to refine the management of chronic wet cough in children. The guidelines recommend further trials to optimize antibiotic regimens and explore recurrence prevention measures for PBB.

Keywords

chronic wet cough

children under 14

Protracted Bacterial Bronchitis

antibiotic efficacy

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

microbiologically-based-PBB

bronchiectasis

primary healthcare research