From the Guidelines
For a 21-month-old child with a cough, the most appropriate initial treatment is a 2-week course of antibiotics targeted to common respiratory bacteria, as recommended by the 2017 Chest guideline and expert panel report 1. This approach is based on the guideline's recommendation for children aged ≤ 14 years with chronic (> 4 weeks’ duration) wet or productive cough unrelated to an underlying disease and without any specific cough pointers.
- The child's age and symptoms align with the guideline's criteria, making antibiotics a suitable initial treatment.
- It is essential to note that the guideline recommends antibiotics targeted to common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) and local antibiotic sensitivities.
- If the cough resolves within 2 weeks of treatment, the diagnosis of protracted bacterial bronchitis (PBB) can be made, as suggested by the guideline 1.
- However, if the cough persists after 2 weeks of appropriate antibiotics, an additional 2 weeks of the appropriate antibiotic(s) may be recommended, as stated in the guideline 1.
- It is crucial to monitor the child's symptoms and adjust the treatment plan accordingly, seeking further investigations if the cough persists or if specific cough pointers are present, such as coughing with feeding or digital clubbing 1.
From the Research
Treatment for Cough in Children
The treatment for cough in a 21-month-old child should be based on the etiology of the cough 2.
- The most common cause of cough in children is viral infection, and in most cases, the cough is self-limiting 3.
- There is no scientific evidence to justify the use of over-the-counter cough remedies, such as anti-tussives, mucolytics, and/or antihistamines, as they could have potentially serious side effects 2, 4, 3, 5.
- The American College of Chest Physicians has recommended a "wait, watch, review" approach for managing acute cough in children, which includes educating parents on expected illness duration and discussing safe, supportive care measures to alleviate the child's discomfort 3.
- Clinicians should carefully evaluate children with persistent cough to rule out specific causes that may include the entire pediatric pulmonology spectrum 2.
- In some cases of "nonspecific chronic cough", empirical treatment based on the cough characteristics may be useful 2.
Safety and Efficacy of Cough Remedies
- Many remedies for cough are self-prescribed, but significant evidence of their efficacy and safety is missing in pediatric populations 6.
- Some treatments have been shown to be no more effective than placebo, and the lack of clear indications for dosing and treatment duration has been considered a contributor to an increased risk of inappropriate prescribing, accidental overdosing, and adverse events 6.