CHEST Guidelines-Response_chest

Response_chest_27 (4)

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The document discusses protracted bacterial bronchitis (PBB) in children and the associated risk of developing bronchiectasis, as addressed by Wurzel et al. The study highlights that a significant portion of children with PBB experience recurrent episodes, and a subset develop bronchiectasis, often linked to Haemophilus influenzae infection, especially its nontypeable form. Sacco and colleagues emphasize monitoring antibiotic adherence to avoid subinhibitory concentrations, which can promote biofilm formation and resistance.<br /><br />The authors suggest that increasing the administration frequency or dosage of antibiotics could maintain therapeutic levels longer, potentially reducing PBB recurrence. However, Wurzel et al. caution against increasing dosing frequency due to potential impacts on patient adherence and the risk of promoting biofilm formation and bacterial resistance. They advocate for educating parents on the importance of adherence to prescribed regimens and highlight the potential benefits of vaccination to improve immunity against Haemophilus influenzae.<br /><br />The exchange underscores the need for further clinical studies to determine optimal treatment strategies for PBB. Both correspondence pieces agree on the relevance of studying biofilms and antibiotic strategies, with the acknowledgment that biofilm presence hinders antibiotic effectiveness, making it crucial to find ways to improve treatment outcomes in children with chronic respiratory issues such as PBB. The discussion stresses the importance of targeted research to guide effective interventions in managing and preventing recurrent PBB and its complications.

Keywords

protracted bacterial bronchitis

children

bronchiectasis

Haemophilus influenzae

antibiotic adherence

biofilm formation

antibiotic resistance

vaccination

chronic respiratory issues

treatment strategies