Protracted bacterial bronchitis
Citation, DOI & article data
Protracted bacterial bronchitis is one of the most common causes of cough in children, particularly those aged <6 years. Is it characterized by a chronic wet cough with no associated cause and tends to respond to 2 weeks of antibiotic therapy.
Protracted bacterial bronchitis is the most common cause of cough in childhood and is 2-3 times more common than asthma 1.
Most children are unable to produce sputum. In the minority of cases where further investigation is performed in the form of bronchoscopy, bronchoalveolar lavage reveals neutrophil infiltration with large numbers of respiratory bacterial pathogens, e.g. Haemophilus influenzae 1.
A variety of diagnostic criteria have been used. The original criteria required confirmation of lower airway infection. The modified criteria are clinical only.
Diagnostic criteria 1:
wet-cough >4 weeks
lower airway infection (confirmed from sputum or BAL)
cough resolved following 2-week course of antibiotics
wet-cough >4 weeks
absence of symptoms or signs of another cause
cough resolved following 2 week course of antibiotics
There is also an extended form of protracted bacterial bronchitis which is defined as taking over 4 weeks to respond to antibiotics.
Recurrent protracted bacterial bronchitis is defined when there are more than 3 episodes in a year.
Radiology involvement is usually not required. Some children will have a chest x-ray as part of the clinical diagnostic criteria to ensure the absence of anything else causing a chronic wet cough.
- 1. Chang A, Upham J, Masters I et al. Protracted Bacterial Bronchitis: The Last Decade and the Road Ahead. Pediatr Pulmonol. 2016;51(3):225-42. doi:10.1002/ppul.23351 - Pubmed
- 2. Marchant J, Masters I, Taylor S, Cox N, Seymour G, Chang A. Evaluation and Outcome of Young Children with Chronic Cough. Chest. 2006;129(5):1132-41. doi:10.1378/chest.129.5.1132 - Pubmed