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Does failed chronic wet cough response to antibiotics predict bronchiectasis?
  1. Vikas Goyal1,2,
  2. Keith Grimwood1,3,
  3. Julie Marchant1,2,
  4. I Brent Masters1,2,
  5. Anne B Chang4,5
  1. 1Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
  2. 2Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia
  3. 3Department of Infectious Diseases, Royal Children's Hospital, Brisbane, Queensland, Australia
  4. 4Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia
  5. 5Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Dr Vikas Goyal, Queensland Children's Medical Research Institute, Level 4, Foundation Building, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia; drvikasgoyal{at}gmail.com

Abstract

Aim To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis.

Methods All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression.

Results Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10–199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5).

Conclusions Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.

  • Respiratory
  • Chronic Wet Cough
  • Bronchiectasis
  • Antibiotics

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