CHEST Guidelines-Recurrence-of-Protracted-Bacterial-Bronchitis-in-C (1)

Recurrence-of-Protracted-Bacterial-Bronchitis-in-C (1)

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The letter discusses findings from a study by Wurzel et al. on the recurrence and risks associated with protracted bacterial bronchitis (PBB) in children, particularly focusing on the development of bronchiectasis. The study found that 43.5% of the 161 children evaluated had more than three episodes of bacterial bronchitis per year, and 8.1% were diagnosed with bronchiectasis. Haemophilus influenzae, primarily in its nontypeable form, was identified as a significant factor, being present in many children, whether or not they developed bronchiectasis.<br /><br />Sacco et al., writing in response to this study, highlighted the role of Haemophilus influenzae in chronic respiratory disorders due to its biofilm-forming ability, which contributes to antibiotic resistance and the likelihood of reinfection. They suggested that adherence to antibiotic treatment should be monitored to avoid subinhibitory concentrations promoting biofilm formation. Additionally, they proposed considering increased or more frequent antibiotic doses in specific cases to maintain appropriate inhibitory concentration levels.<br /><br />The reference to beta-lactam antibiotics indicates they may inadvertently promote biofilm transformation in Haemophilus influenzae, thus exacerbating the cycle of infection and resistance. The letter calls for careful management of antibiotic therapies to improve outcomes for children with PBB and associated risks like bronchiectasis.<br /><br />The document also notes no financial conflicts from the authors, and a response from Wurzel et al. acknowledges and appreciates Sacco et al.'s interest and agrees with the observations, aligning with the study's findings that nontypeable Haemophilus influenzae and recurrent PBB episodes are significant factors for bronchiectasis development.

Keywords

protracted bacterial bronchitis

bronchiectasis

Haemophilus influenzae

children

antibiotic resistance

biofilm formation

beta-lactam antibiotics

recurrent infections

antibiotic therapy

Wurzel et al.