Debates Surrounding Antibiotic Treatment for Chronic Wet Cough in Pediatric Patients

Chronic cough is a frequent concern in pediatric primary care, generally defined as a cough lasting more than four weeks. Guidelines for evaluating chronic cough in children differentiate between dry and wet coughs, as they indicate distinct clinical entities. Wet cough often suggests the presence of airway secretions. However, research shows variability in parents’ ability to accurately differentiate between dry and wet coughs.
Protracted Bacterial Bronchitis (PBB) is a common cause of chronic wet cough, characterized by a bacterial infection in the lower airways. The gold standard for diagnosing PBB is flexible bronchoscopy with lavage to confirm inflammation and bacterial overgrowth. However, this procedure is invasive and requires specialized facilities. Consequently, guidelines from specialty centers, particularly in Australia, recommend empirical antibiotic treatment if no other causes of cough are identified, avoiding the need for invasive diagnostics.
Chronic cough can also result from a variety of conditions including asthma, sinusitis, upper airway cough syndrome, gastroesophageal reflux disease, tuberculosis, and more. Improvement with a two-week course of antibiotics supports a diagnosis of clinical PBB. Effective empirical treatment can eliminate the need for referral to specialty centers, reducing healthcare costs and time burdens for families.
Concerns about antibiotic use include the potential for resistance, adverse effects, and impacts on the microbiome. Each additional day of antibiotics can increase the odds of adverse events. Antimicrobial stewardship programs aim to optimize antibiotic prescribing to mitigate these risks.
There is a need for further research, particularly in primary care settings in North America, to evaluate the effectiveness of antibiotics for chronic wet cough. Prospective clinical trials and the development of objective cough measurement tools could provide better diagnostic accuracy and guide appropriate treatment. Current studies suggest that new technologies and noninvasive biomarkers could reduce unnecessary antibiotic use and improve patient care.