Persistent/Protracted Bacterial
Bronchitis (PBB aka chronic wet cough)
Bronchitis in children
controversy about term
v different to how it is in adults
in adults: wheeze + coarse crackles
in children: cough + fever
may persist for 2+wks, esp with pertussis or mycoplasma
no evidence that antibiotics, cough suppressants or expectorants speed recovery
Dx
clinical criteria for establishing this dx are somewhat nonspecific
cough that persists for at least 3-4 wks + resolves with antimicrobial therapy
Comps
If untxed may lead to chronic suppurative lung disease or bronchiectasis
flexible bronchoscopy of lower airways demonstrates oedema + increased bronchial secretions
+ve bacterial culture following bronchoalveolar lavage
Predominant organisms
Strep pneumo
nontypable Haemophilus influenzae
Moraxella catarrhalis
Management
antibiotics for 3-4 wks
Further investigation (chest CT, immunologic testing) advised for patients who don't experience improvement in sx