What is the recommended treatment for a 5-year-old patient presenting with bronchitis?

Treatment of Bronchitis in a 5-Year-Old

Antibiotics should NOT be used for a 5-year-old with acute bronchitis, as this is a viral illness that resolves with supportive care alone. 1

Understanding the Diagnosis

At age 5, this child has acute bronchitis, not bronchiolitis. This distinction is critical:

• Bronchiolitis is a small airway disease that primarily affects infants under 2 years of age, making this diagnosis unlikely at age 5 1
• Acute bronchitis in a 5-year-old is characterized by cough due to acute inflammation of the trachea and large airways, typically caused by viruses 2
• The cough typically lasts 2-3 weeks, and parents must be counseled that this duration is normal and does not indicate treatment failure 1, 2

Recommended Treatment Approach

What TO Do: Supportive Care Only

• Symptomatic treatment is the mainstay, including management of fever and ensuring adequate hydration 2
• Patient and family education about the expected 2-3 week duration of cough is essential to prevent unnecessary return visits or antibiotic requests 2
• Assess for warning signs that would suggest pneumonia instead: look for tachypnea (respiratory rate >50 breaths/min in this age group), difficulty breathing, oxygen saturation <92%, or signs of dehydration 3

What NOT To Do: Avoid Routine Interventions

• Do not prescribe antibiotics routinely - they provide minimal benefit (reducing cough by only half a day) while causing adverse effects including allergic reactions, nausea, vomiting, and Clostridium difficile infection 2
• Do not use bronchodilators routinely for uncomplicated acute bronchitis 1
• Do not order chest radiographs or laboratory studies unless pneumonia is suspected based on clinical findings 3

When to Consider Alternative Diagnoses or Treatments

Trial of Bronchodilators (Selective Use Only)

• If wheezing accompanies the cough, a trial of β2-agonist bronchodilators may be useful 1
• Continue bronchodilators ONLY if there is documented clinical improvement in wheezing, respiratory rate, respiratory effort, and oxygen saturation 1
• This represents a carefully monitored therapeutic trial, not routine treatment 1

Suspect Pertussis and Treat Immediately If:

• Cough persists >2 weeks with paroxysmal cough, whooping cough, post-tussive emesis, or recent pertussis exposure 2
• If pertussis is suspected, a macrolide antibiotic is mandatory, and the child must be isolated for 5 days from treatment start 1

Suspect Pneumonia and Consider Antibiotics If:

• Respiratory rate >50 breaths/min, oxygen saturation <92%, difficulty breathing, or grunting 3
• First-line antibiotic for community-acquired pneumonia in this age group is amoxicillin, as it covers Streptococcus pneumoniae effectively 3
• Consider macrolides (erythromycin, clarithromycin, azithromycin) as first-line in children ≥5 years, given higher prevalence of Mycoplasma pneumoniae in this age group 3

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on parental pressure or cough duration alone - the natural course is 2-3 weeks 2
• Do not confuse acute bronchitis with bronchiolitis - the latter affects infants <2 years and has different management 1
• Do not miss pneumonia - if the child has tachypnea, increased work of breathing, or persistent fever beyond 48 hours, reassess for pneumonia 3
• Do not overlook pertussis - prolonged cough (>2 weeks) with characteristic features requires macrolide therapy and isolation 1, 2