Zusammenfassung
Die protrahiert-bakterielle Bronchitis ist definiert als mehrwöchige bronchiale Infektion durch Bakterien, wodurch es zu täglichem feuchtem Husten über mindestens 4 Wochen kommt. Virale Infektionen gehen häufig voraus, und andere chronische Atemwegserkrankungen müssen ausgeschlossen werden. Die Diagnose wird primär klinisch gestellt. Eine mindestens 2-wöchige Antibiotikagabe wird bei der Hälfte der Kinder zu einer deutlichen Besserung führen. Bei den restlichen Kindern soll eine genauere Abklärung mithilfe der flexiblen Bronchoskopie, bronchoalveolärer Lavage und evtl. weiterer Untersuchungen erfolgen. Die am häufigsten nachgewiesenen Bakterien sind Haemophilus influenzae, Moraxella catarrhalis und Streptococcus pneumoniae. Potenzielle weitere Therapieoptionen, die bisher noch nicht ausreichend in Studien für diese Indikation untersucht wurden, sind tägliche Inhalationen mit β-Mimetika und/oder hypertoner NaCl-Lösung, verschiedene Thoraxphysiotherapieformen und die mehrwöchige bis mehrmonatige Gabe von Azithromycin.
Abstract
Protracted bacterial bronchitis (PBB) is defined as a chronic (several weeks) bronchial infection and inflammation caused by bacteria, the presence of isolated chronic wet cough and absence of pointers suggestive of other specific chronic airway diseases. Primarily, it is diagnosed clinically and the cough resolves only after a prolonged course of appropriate antibiotics. Almost half of the affected children need several courses of antibiotics and many show a relapse. In these children further investigations, such as imaging, bronchoscopy, bronchoalveolar lavage and exclusion of alternative causes are warranted. The most common pathogens found in bronchial secretions of children with PBB are Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumonia. Not yet sufficiently investigated additional treatment options are inhalation of beta agonists and/or hyperosmolar solutions, physiotherapy and long-term administration of azithromycin.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Baines KJ, Upham JW, Yerkovich ST et al (2014) Mediators of neutrophil function in children with protracted bacterial bronchitis. Chest 146(4):1013–1020
Chang AB, Brown N, Toombs M et al (2014) Lung disease in indigenous children. Paediatr Respir Rev 15(4):325–332
Chang AB, Redding GJ, Everard ML (2008) Chronic wet cough: protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatric Pulmonol 43:519–531
Craven V, Everard ML (2012) Protracted bacterial bronchitis: reinventing an old disease. Arch Dis Child 98:72–76
Donnelly D, Critchlow A, Everard ML (2007) Outcomes in children treated for persistent bacterial bronchitis. Thorax 62:80–84
Grissell TV, Chang AB, Gibson PG (2007) Impaired toll-like receptor 4 and substance P gene expression isassociated with airway bacterial colonization in children. Pediatr Pulmonol 42:380–385
Kompare M, Weinberger M (2012) Protracted bacterial bronchitis in young children: association with airway malacia. J Pediatr 160(1):88–92
Marchant J, Masters IB, Champion A et al (2012) Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax 67(8):689–693
Marchant JM, Morris PS, Gaffney JT, Chang AB (2005) Antibiotics for prolonged moist cough in children. Cochrane Database Syst Rev 4:CD004822
Marchant JM, Masters IB, Taylor SM et al (2006) Evaluation and outcome of young children with chronic cough. Chest 129:1132–1141
Narang R, Bakewell K, Peach J et al (2014) Bacterial distribution in the lungs of children with protracted bacterial bronchitis. PLoS One 9(9):e108523
O’Grady KA, Grimwood K, Cripps A et al (2013) Does a 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine prevent respiratory exacerbations in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: protocol for a randomised controlled trial. Trials 14:282
Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ et al (2014) Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther 143(2):225–245
Priftis KN, Litt D, Manglani S et al (2013) Bacterial bronchitis caused by Streptococcus pneumoniae and nontypable Haemophilus influenzae in children: the impact of vaccination. Chest 143(1):152–157
Pritchard MG, Lenney W, Gilchrist FJ (2015) Outcomes in children with protracted bacterial bronchitis confirmed by bronchoscopy. Arch Dis Child 100:112
Shields MD, Doherty GM (2013) Chronic cough in children. Paediatr Respir Rev 14(2):100–105
Strålin K, Korsgaard J, Olcén P (2006) Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage. Eur Respir J 28(3):568–575
Taussig LM, Smith SM, Blumenfeld R (1981) Chronic bronchitis in childhood: what is it? Pediatrics 67:1–5
Wurzel DF, Mackay IM, Marchant JM et al (2014) Adenovirus species C is associated with chronic suppurative lung diseases in children. Clin Infect Dis 59(1):34–40
Wurzel DF, Marchant JM, Yerkovich ST et al (2014) Prospective characterization of protracted bacterial bronchitis in children. Chest 145(6):1271–1278
Zacharasiewicz A, Eber E, Riedler J, Frischer T (2015) Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 163:248–256
Zgherea D, Pagala S, Mendiratta M et al (2012) Bronchoscopic findings in children with chronic wet cough. Pediatrics 129:e364–e369
Einhaltung ethischer Richtlinien
Interessenkonflikt. J. Riedler gibt an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Riedler, J. Protrahiert-bakterielle Bronchitis. Monatsschr Kinderheilkd 163, 1241–1245 (2015). https://doi.org/10.1007/s00112-015-3385-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00112-015-3385-9