What is the recommended treatment for a 5-year-old patient with bronchitis, presenting with symptoms of cough, fever, headaches, nausea, and diarrhea?

Treatment of Bronchitis in a 5-Year-Old Child

Critical Diagnostic Clarification

This 5-year-old child does NOT have bronchiolitis (which affects infants under 2 years), but rather acute bronchitis, which is almost always viral and requires supportive care only—antibiotics should NOT be used. 1, 2

Immediate Management: Supportive Care Only

What TO Do:

• Provide symptomatic treatment with rest, fluids, and antipyretics (acetaminophen or ibuprofen) for fever and headache. 1, 2
• Educate the family that cough typically lasts 2-3 weeks, which is normal and does not indicate treatment failure. 1, 2
• Manage nausea and ensure adequate hydration, especially given the diarrhea—oral rehydration is preferred unless the child cannot maintain adequate intake. 3
• Monitor for signs of respiratory distress (respiratory rate >50 breaths/min, difficulty breathing, grunting, oxygen saturation <92%) that would indicate need for urgent evaluation. 3

What NOT To Do:

• Do NOT prescribe antibiotics—acute bronchitis is viral in over 90% of cases, and antibiotics provide minimal benefit (reducing cough by only half a day) while causing adverse effects including allergic reactions, nausea, vomiting, and C. difficile infection. 1, 2, 4
• Do NOT use cough and cold preparations, as the FDA recommends against these in children under 6 years. 2
• Do NOT routinely order chest radiographs or laboratory studies unless pneumonia is suspected. 1, 5

When to Escalate Care

Indicators for Urgent Evaluation or Admission:

• Respiratory rate >50 breaths/min in a 5-year-old. 3
• Oxygen saturation <92% or cyanosis. 3
• Signs of respiratory distress: grunting, difficulty breathing, intercostal retractions. 3
• Signs of dehydration from vomiting/diarrhea. 3
• Altered consciousness or extreme pallor. 3
• Fever with inability to maintain oral intake for >24 hours. 3

Rule Out Pneumonia

When to Suspect Pneumonia Instead:

• If the child has tachypnea (>50 breaths/min), tachycardia, dyspnea, or lung findings suggestive of pneumonia (focal crackles, decreased breath sounds), pneumonia should be suspected and chest radiography is warranted. 1, 5
• For school-aged children with suspected bacterial pneumonia, amoxicillin is the first-line antibiotic. 3, 5
• If atypical pathogens (Mycoplasma) are suspected in school-aged children, a macrolide antibiotic should be prescribed. 3, 5

Special Consideration: Pertussis

• If cough persists beyond 2 weeks with paroxysmal cough, whooping, or post-tussive emesis, consider pertussis and use antibiotics to reduce transmission. 1, 2

Communication Strategy

• Call this a "chest cold" rather than "bronchitis" to reduce patient expectations for antibiotics. 1
• Emphasize that the natural course is 2-3 weeks of cough, and this is normal viral illness resolution. 1, 2
• Explain that antibiotics will not help viral infections and carry risks of side effects. 1, 4

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on colored (green) sputum—this does NOT reliably differentiate bacterial from viral infection. 2
• Do not assume fever alone indicates bacterial infection requiring antibiotics—most acute bronchitis is viral even with fever. 1, 2
• Do not overlook dehydration risk from combined vomiting/diarrhea—this may require more aggressive fluid management than the respiratory symptoms. 3