Antibiotic therapy for protracted bacterial bronchitis in children

Before prescribing antibiotic therapy for protracted bacterial bronchitis in children, exclude other causes of chronic cough – see Definition and clinical features of protracted bacterial bronchitis in childrenLung Foundation Australia, 2022. If the cause of cough is uncertain, prescribe antibiotic therapy for protracted bacterial bronchitis in consultation with a paediatrician.

Protracted bacterial bronchitis is typically caused by lower airways infection with nontypeable Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis.

For protracted bacterial bronchitis in children, useChang, Oppenheimer, , 2016Chang, Upham, , 2016Lung Foundation Australia, 2022Marchant, 2012Wurzel, 2014:

1amoxicillin+clavulanate (child 2 months or older) 22.5+3.2 mg/kg up to 875+125 mg orally, 12-hourly1; see advice on patient review and duration of therapy amoxicillin + clavulanate

OR

2cefuroxime (child 3 months or older) 15 mg/kg up to 500 mg orally, 12-hourly2; see advice on patient review and duration of therapy. cefuroxime

For children with protracted bacterial bronchitis who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefuroxime at the dosage above.

For children with protracted bacterial bronchitis who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin or who require an alternative oral liquid formulation, use:

trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg orally, 12-hourly; see advice on patient review and duration of therapy. trimethoprim + sulfamethoxazole

1 Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return
2 Cefuroxime is preferred to cefalexin or cefaclor because of its superior antipneumococcal activity; see Practical information on using beta lactams: cephalosporins for further information.Return
3 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return