Antibiotics are an appropriate and effective option for the treatment of wet or productive cough in children, with literature supporting the use of amoxicillin clavulanate or erythromycin, according to a Cochrane review.
“Our knowledge of childhood wet cough has progressed greatly in the last decade. We now know that one of the most common causes of childhood chronic wet cough is protracted bacterial bronchitis in Australia, Europe and similar populations,” Julie M. Marchant, PhD, a senior research fellow at the Child Health Research Center in South Brisbane, Australia, told Infectious Diseases in Children. “[Chronic wet cough] has now been incorporated into pediatric cough guidelines worldwide.”
Marchant said that although the findings of this review were not a surprise to her, the broader medical community may still be unaware of studies on the topic.
To examine how effective antibiotic treatment is in children with chronic wet cough without bronchiectasis or other previously known respiratory illness — as well as the risk of adverse events related to treatment — the researchers conducted a review of three randomized controlled trials. Each trial included a placebo group for comparison, and cluster or cross-over trials were excluded from the review.
Marchant and colleagues said two of the studies had high or unclear risk of bias and one had a low risk of bias. The duration of treatment ranged from 7 to 14 days. Two studies used amoxicillin clavulanate acid for the treatment of wet cough, whereas one used erythromycin.
Of the 190 children aged between 21 months and 6 years included in the meta-analysis, 171 completed treatment. When antibiotics were used for treatment, children were more likely to be cured at follow-up (OR = 0.15; 95% CI, 0.07-0.31).
The researchers noted that two of the trials examined the progression of illness related to wet cough, which was defined as the need for additional antibiotics. This was required for 125 children. Children who received antibiotics were significantly less likely to need additional treatment (OR = 0.1; 95% CI, 0.03-0.34).
All three trials reported adverse events, but a significant increase in risk was not observed between the antibiotic groups compared with the control groups (OR = 1.88; 95% CI, 0.62-5.69).
“Current guidelines suggest the use of amoxicillin clavulanate as first-line therapy except in cases of allergy,” Marchant said. “This is because the most common organisms found on bronchoalveolar lavage in children with chronic wet cough are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and amoxicillin-clavulanic acid is an antibiotic with broad coverage of these organisms. In contrast, with the increasing emergence of macrolide resistance to these common pathogens may limit their usefulness in the future, and macrolide antibiotics like erythromycin are not recommended as first-line treatment.” – by Katherine Bortz