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Cough Illness in the Well-appearing Child

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 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 less than 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 (greater than 10-14 days without improvement) may suggest specific illnesses (e.g. sinusitis) that warrant antibiotic treatment⁵
• Treatment with a macrolide (erythromycin) may be warranted in the child older than 5 years when mycoplasma or pertussis is suspected⁶

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

References

1. O'Brien 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 placebocontrolled trials of antibiotics for acute bronchitis: a critical review of the literature. J Fam Pract 1993;36:507512.
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;12:115120.
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;123:7492.