Protracted bacterial bronchitis: a common problem with no agreed solution

Protracted bacterial bronchitis (PBB) is caused by a bacterial infection of the conducting airways in children who are otherwise healthy. It is the leading cause of chronic wet cough in young children and the most common reason for referrals to the Paediatric Respiratory Clinics in the UK. 1 The cough has a negative effect on the quality of life of the affected child and their family. 2 If PBB is left untreated, it has been postulated that ongoing endobronchial infection may be a risk factor in the development of bronchiectasis. 3 The diagnosis is based on the presence of an isolated wet cough for >4 weeks, the absence of an identifiable alternative cause and the resolution of cough with appropriate antibiotics.

Although response to antibiotics is part of the diagnostic criteria for PBB, we do not know the optimum duration of this initial treatment. The 2008 UK National Paediatric Cough Guideline suggests using 4-6 weeks of oral antibiotics. This recommendation...