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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.

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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.

Keywords:
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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.