What treatment is recommended for a child with a cold lasting 2 weeks?

Management of a Child's Cold Lasting 2 Weeks

For a child with a cold lasting 2 weeks, antibiotics are recommended if the cough is wet/productive, as this likely represents protracted bacterial bronchitis (PBB) requiring 2 weeks of antibiotics targeted at common respiratory bacteria. 1, 2

Assessment and Classification

• Determine if specific "cough pointers" are present (coughing with feeding, digital clubbing) which would suggest underlying disease requiring targeted treatment 1, 2
• Assess for signs of bacterial sinusitis, which may include:
  • Persistent illness with nasal discharge and/or daytime cough lasting >10 days without improvement
  • Worsening course after initial improvement
  • Severe onset with high fever (≥39°C) and purulent nasal discharge for at least 3 consecutive days 1, 2
• Evaluate for paroxysmal cough with post-tussive vomiting or inspiratory "whoop" which may suggest pertussis 1, 3

Management Recommendations

For Wet/Productive Cough (PBB)

• If the child has a wet/productive cough that has persisted for >2 weeks, administer antibiotics targeted to common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) for 2 weeks 1
• If the wet cough persists after 2 weeks of appropriate antibiotics, provide an additional 2 weeks of antibiotics 1
• If the wet cough persists after 4 weeks of appropriate antibiotics, further investigations (e.g., flexible bronchoscopy, chest CT) should be undertaken 1

For Non-Specific Cough

• Re-evaluate for emergence of specific etiological pointers if cough does not resolve within 2-4 weeks 1
• Consider a short trial of inhaled corticosteroids (400 mg/day of beclomethasone equivalent for 2-4 weeks) if risk factors for asthma are present 1
• Avoid over-the-counter cough and cold medicines, especially in children under 6 years, as they lack efficacy and have potential adverse effects 1, 4

For Suspected Bacterial Sinusitis

• Consider antibiotics if symptoms persist beyond 10 days without improvement, worsen after initial improvement, or present with high fever and purulent nasal discharge for ≥3 consecutive days 1, 5
• Imaging is not recommended for uncomplicated cases as it does not change management 1

For Suspected Pertussis

• If paroxysmal cough with post-tussive vomiting or inspiratory "whoop" is present, treat with macrolide antibiotics (erythromycin, azithromycin, or clarithromycin) 1, 3
• Therapy should begin as soon as pertussis is suspected, without waiting for confirmation 1
• Isolate the patient at home for 5 days after starting antibiotics 1

Supportive Care Measures

• Ensure adequate hydration to help thin secretions 2
• Use saline nasal drops to relieve nasal congestion 2, 6
• Elevate the head of the bed to improve breathing during sleep 2
• Consider honey for symptomatic relief in children over 1 year of age 2, 6
• Avoid environmental irritants such as tobacco smoke 2

When to Seek Immediate Medical Attention

• Development of high fever (≥39°C) 2, 7
• Signs of respiratory distress (increased respiratory rate, retractions, grunting) 2
• Change in sputum color to yellow/green (purulent) 2
• Development of paroxysmal cough with post-tussive vomiting or inspiratory "whoop" 1, 3

Important Considerations

• The distinction between viral and bacterial causes is critical for appropriate management 1
• Antibiotics are not indicated for initial management of transparent sputum and runny nose without fever 2, 5
• For children with specific cough pointers, further investigations should be undertaken to assess for underlying disease 1, 2

The management approach differs significantly based on cough characteristics and duration, with antibiotics being indicated for wet/productive cough lasting more than 2 weeks (PBB) or when specific criteria for bacterial sinusitis or pertussis are met 1, 2.