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How common is childhood bronchitis? At what point should I treat a child with a moist sounding cough, but no other signs of infection. Is there a length of time that one should see a resolution of a cough without treatment with antibiotics? Unlike adults, bronchitis is uncommon in children and some authorities question whether the entity exists at all. At times the term "wheezy bronchitis" has been used in children, as has been alluded to in the question. Most upper and lower respiratory tract infections in children are caused by viruses and do not require any specific treatment . The uncomplicated viral infection usually lasts 5 to 7 days and although some children may not be asymptomatic, they are virtually always improved by the 10th day. The cough in these children is usually accompanied by an initial watery nasal discharge which often becomes thicker and colored or opaque after a few days and then becomes clear again to a mucoid watery consistency before resolving spontaneously. The typical course of this viral illness should be explained to the parent and it must be emphasized that antibiotics are not required simply because the change in colour of the mucoid nasal discharge. The indications for antibiotic use would be in a child who is unwell, toxic, has signs of pneumonia (crackles, tachypnoea) or an accompanying purulent otitis-media, or in whom the cough has persisted beyond ten to fourteen days without appreciable improvement. Inhaled steroids and bronchodilators should be reserved for those children who have obvious bronchospasm, a history of previous episodes of bronchospasm particularly with viral illnesses or in whom the cough is significantly worse at night or with exercise, laughing or crying. The most common bacterial pathogen causing lower respiratory tract infections in children in all age groups is Streptococcus pneumoniae. Non-typable Haemophilus influenzae may be a significant pathogen in preschoolers (£5 years) while Mycoplasma pneumoniae may be significant in school age children (5-18years). The antibiotic of choice in children less than five years of age is amoxicillin (40 mg/kg daily in three divided doses). Erythromycin (40 mg/kg daily in four divided doses) or clarithromycin (15 mg/kg daily in two doses) for seven days, is the drug of choice in children ³5 years of age or in those who have a penicillin allergy.
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