CHEST Guidelines-Recurrence-of-Protracted-Bacterial-Bronchitis-in-C (2)

Recurrence-of-Protracted-Bacterial-Bronchitis-in-C (2)

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In a recent correspondence published in CHEST, the article by Wurzel et al. on protracted bacterial bronchitis (PBB) in children was discussed and analyzed, particularly its natural history and the risks of progressing to bronchiectasis. The study revealed that a significant proportion of the 161 children with PBB experienced multiple episodes of bacterial bronchitis annually, with a subset diagnosed with bronchiectasis. The prevalent presence of Haemophilus influenzae, particularly in a nontypeable form, was identified in these children, with higher concentrations in those who developed bronchiectasis.<br /><br />Dr. Sacco and colleagues from the Istituto Giannina Gaslini remarked on the recognized role of nontypeable Haemophilus influenzae in chronic respiratory disorders due to its biofilm-forming capability. Such biofilm formation can be problematic when encouraged by subinhibitory concentrations of beta-lactam antibiotics, which may inadvertently promote antibiotic resistance and recurrent infections. They advocate for careful monitoring of antibiotic adherence and potential adjustments in dosage or frequency to mitigate recurrence risks in PBB.<br /><br />The authors further highlight the compromised immune response in these children, emphasizing the importance of maintaining effective antibiotic concentrations to minimize the recurrence of bronchitis episodes. This response underscores the need for strategic antibiotic administration tailored to sustain higher inhibitory concentrations over more extended periods.<br /><br />The correspondence elucidates the complexities of managing PBB in children and the pivotal role of Haemophilus influenzae in exacerbating conditions that may lead to bronchiectasis. It emphasizes an adaptive approach to antibiotic treatment to curb the recurrence of infection and disease progression.

Keywords

protracted bacterial bronchitis

children

bronchiectasis

Haemophilus influenzae

nontypeable

biofilm

antibiotic resistance

immune response

antibiotic adherence

chronic respiratory disorders