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Does failed chronic wet cough response to antibiotics predict bronchiectasis?
Vikas Goyal1, Keith Grimwood2, Julie Marchant1
1Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia.
Insights
Children with chronic wet cough unresponsive to antibiotics are significantly more likely to have bronchiectasis. Further investigation is recommended for persistent symptoms, as antibiotic response alone doesn't rule out this condition.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Infectious Diseases
Background:
- Chronic wet cough in children can be challenging to diagnose.
- Persistent respiratory symptoms may indicate underlying conditions like bronchiectasis.
- Assessing the response to antibiotic treatment is a common diagnostic step.
Purpose of the Study:
- To evaluate the association between chronic wet cough unresponsive to antibiotics and the likelihood of pediatric bronchiectasis.
- To determine if multi-detector computerised tomography (MDCT) findings correlate with antibiotic response in children with persistent cough.
Main Methods:
- Retrospective review of chest MDCT scans in children with chronic wet cough.
- Analysis of clinical data, including antibiotic response and demographic factors.
- Logistic regression used to assess associations between variables and bronchiectasis diagnosis.
Main Results:
- Children with chronic wet cough persisting after 4 weeks of antibiotics had an 83.8% rate of bronchiectasis.
- Only 25% of children whose cough resolved with antibiotics were diagnosed with bronchiectasis (adjusted OR 20.9).
- Indigenous ethnicity was also independently associated with bronchiectasis (adjusted OR 5.86).
Conclusions:
- MDCT scans are recommended for children with chronic wet cough unresponsive to 4 weeks of oral antibiotics.
- While a positive response to antibiotics may reduce the likelihood, it does not entirely exclude bronchiectasis.
- Early investigation is crucial for accurate diagnosis and management of pediatric bronchiectasis.
Aim:
To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis.
Methods:
All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression.
Results:
Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10-199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5).
Conclusions:
Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.
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