From the Research
Persistent bacterial bronchitis (PBB) is a chronic respiratory condition characterized by a wet, productive cough that lasts for more than four weeks, caused by bacterial infection in the airways. It primarily affects children but can occur in adults as well. The condition develops when bacteria colonize the lower airways, leading to inflammation, increased mucus production, and impaired mucociliary clearance. Common causative bacteria include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Treatment typically involves a prolonged course of antibiotics, usually amoxicillin-clavulanate at a dose of 45 mg/kg/day divided twice daily for 2-4 weeks 1. For patients with penicillin allergies, alternatives include clarithromycin or azithromycin. In severe or recurrent cases, a longer course of 6 weeks may be necessary. Airway clearance techniques and addressing any underlying conditions like immunodeficiency or anatomical abnormalities are also important. If left untreated, PBB can lead to bronchiectasis, a permanent dilation and damage to the airways. Diagnosis is based on clinical presentation, response to antibiotics, and exclusion of other causes of chronic cough such as asthma, cystic fibrosis, or foreign body aspiration. The recent recognition that the conducting airways are not "sterile" and that they have their own dynamic microbiome, together with the rapid advances in our understanding of microbial biofilms and their roles in the causation of respiratory diseases, permit us to update the "vicious circle" hypothesis of the causation of bronchiectasis 2. Understanding the complex interaction between the host and the microbial communities of the conducting airways in health and disease will be a key component in optimizing pulmonary health in the future. Some studies have shown that intermittent prophylactic antibiotics can reduce the frequency of exacerbations in adults with bronchiectasis, but this is associated with an increased risk of antibiotic resistance 3. However, the impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits. Overall, the management of PBB should focus on reducing the frequency of exacerbations, improving quality of life, and preventing the development of bronchiectasis.
Some key points to consider in the management of PBB include:
- The use of prolonged courses of antibiotics to treat PBB
- The importance of airway clearance techniques and addressing underlying conditions
- The need to exclude other causes of chronic cough
- The potential risks and benefits of intermittent prophylactic antibiotics
- The importance of understanding the complex interaction between the host and the microbial communities of the conducting airways in health and disease.
In terms of specific treatments, amoxicillin-clavulanate is a commonly used antibiotic for the treatment of PBB, and alternatives such as clarithromycin or azithromycin may be used in patients with penicillin allergies 1. However, the choice of antibiotic and the duration of treatment should be individualized based on the specific needs of the patient and the severity of the disease. Further research is needed to establish the optimal treatment strategies for PBB and to improve our understanding of the complex interactions between the host and the microbial communities of the conducting airways in health and disease.