Cough illness/bronchitis is principally caused by viral pathogens.2 Airway inflammation and sputum production are non-specific responses and do not imply a bacterial etiology.
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Authors of a meta-analysis of six randomized trials (in adults) concluded that antibiotics were ineffective in treating cough illness/bronchitis.3
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Antibiotic treatment of upper respiratory infections do not prevent bacterial complications such as pneumonia.4
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Do not use antibiotics for: |
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Cough <10-14 days in well-appearing child
without physical signs of pneumonia. |
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Consider antibiotics only for: |
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Suspected pneumonia, based on fever with focal exam, infiltrate on chest x-ray, tachypnea, or toxic appearance.
Prolonged cough (>10-14 days without
improvement) may suggest specific illnesses (e.g. sinusitis) that warrant antibiotic treatment.5
Treatment with a macrolide (erythromycin)
may be warranted in the child older than 5
years when mycoplasma or pertussis is
suspected.6 |
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When parents demand antibiotics... |
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Acknowledge the child’s symptoms and
discomfort.
Promote active management with
non-pharmacologic treatments.
Give realistic time course for resolution.
Share the CDC/AAP principles and pamphlets with parents to help them understand when the risks of antibiotic treatment outweigh the benefits.
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| References |
| 1. |
OBrien KL, Dowell SF, Schwartz B, Marcy SM, Phillips WR, Gerber MA. Cough illness/bronchitis principles of judicious use of antimicrobial agents. Pediatrics 1998;101:178-181. |
| 2. |
Chapman RS, Henderson FW, Clyde WA, Collier AM, Denny FW. The epidemiology of tracheobronchitis in pediatric practice. Am J Epidemiol 1981;114:789-797. |
| 3. |
Orr PH, Scherer K, Macdonald A, Moffatt MEK. Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the literature. J Fam Pract 1993;36:507-512. |
| 4. |
Gadomski AM. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatr Infect Dis J 1993;12:115-120. |
| 5. |
Wald E. Management of Sinusitis in infants and Children. Pediatr Infect Dis J 1988;7:449-452. |
| 6. |
Denny FW, Clyde WA, Glezen WP. Mycoplasma pneumoniae disease clinical spectrum, pathophysiology, epidemiology and control. J Infect Dis 1971;123:74-92. |
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