Cough Illness/Bronchitis: Physician Information Sheet (Pediatrics)

Careful Antibiotic Use

Cough illness in the well-appearing child: Antibiotics are NOT the answer.

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Cough Illness / Bronchitis¹

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.

Authors of a meta-analysis of six randomized trials (in adults) concluded that antibiotics were ineffective in treating cough illness/bronchitis.³

Antibiotic treatment of upper respiratory infections do not prevent bacterial complications such as pneumonia.⁴

• Do not use antibiotics for:
  • Cough <10-14 days in well-appearing child without physical signs of pneumonia.
• Consider antibiotics only for:
  • 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
• When parents demand antibiotics...
  • 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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