I took my 4 year old girl to the doctor today for a cough she’s had for close to two weeks. After an exam, the doctor diagnosed bronchitis and prescribed amoxicillin. OK, fine. But he seemed very hesitant to make that diagnosis, and he even commented aloud that he was surprised he was doing this. He mentioned that this type of diagnosis with a child this age was somewhat controversial because it’s so rare and some professionals doubt that bronchitis occurs in children this young. Wait, what?
So, I’m certainly not asking for medical advice; I’m asking about this controversy. Is the medical community split about whether children this young really get bronchitis? What’s the deal here, why the controversy?
Perhaps DSeid will pop by. Being a pediatrician, I’m sure he can explain it better than I.
Briefly, most children under 2 years don’t get bronchitis, an inflammation of the tracheobronchial tree, they get bronchiolitis, an inflammation of the small airways. And most pre-adolescent kids also get bronchiolitis far more often than bronchitis.
Add to that the fact that 99+% of bronchiolitis is viral, and thus not responsive to antibiotics, and you can see why the medical community doesn’t want unnecessary med prescribed.
And frankly, 98+% of acute bronchitis is probably non-bacterial also, and doesn’t need antibiotics.
As a kid who suffered from what was diagnosed as bronchitis at age 7, three and a half decades ago, I’m curious what the current appropriate treatment would be these days.
Bronchitis?asthma, as a kid, with some high power drugs that left my heart in a big pitter patter. Like so many things, the understanding of the intricacy has progressed well, so, what’s new there?
The amoxicillin is being used as what I like to call a “potion.” It’s a prescription medicine but antibiotic-amenable organisms that cause persistent cough in children (mycoplasma; pertussis; chlamydia…etc) do not respond to amoxicillin and most causes (by far) are not from antibiotic-amenable organisms anyway. Viruses are very common for instance. The amox is a way of giving something but it’s not really given with the idea that it’s going to be actual effective therapy for a likely organism.
Kid comes in with a persistent cough. Doesn’t look like pneumonia or asthma or an allergy. What is it? Is it pertussis? Mycoplasma? Should we do a fancy workup? Is it just that the kid’s bronchial lining is irritated by the coughing that started with a long-gone organism but is now persisting because the coughing itself perpetuates the irritation that perpetuates the cough that perpetuates the irritation? If the kid looks good sometimes we just do something, even when the best advice might be: Don’t just do something; just stand there.
That can be a harder and longer sell than giving amox while it goes quietly away on its own.
While I’m on the subject of antibiotics: Just because something is caused by an antibiotic-sensitive organsim doesn’t mean it has to, or even should, be treated with antibiotics. Lots of infections get better on their own. It’s a different story, of course, if the patient is getting behind the eightball.
My son last year at 7 months had the very heavy constricted breathing (spent an overnight at the hospital). They diagnosed it as bronchiolitis or “reactive airways”. They were hesitant to diagnose him as having asthma but said it was very likely he would have it when he got older.
Treatment consisted of using a nebulizer (inhaler device) with treatments of Pulmicort and Albuterol. I’m not sure if it was really a “treatment” or more of a wat to control it.
Yep. Bronchiolitis is a separate thing altogether; typically ascribed to the Respiratory Syncytial Virus. In littler children, especially, the target area is the bronchioles, so this makes a typical RSV bronhiolitis a lower respiratory illness versus the bronchitis referenced in the OP. Bronchiolitis tends to be more acute in onset and typically not as prolonged as the situation Scruloose describes, although a baby can be very ill with it.
What do you do about a doctor that just gives you antibiotics to make it seem like he is doing something?
Personally I switched doctors because of this. I went in with a bad persistent cough and was prescribed an antibiotic. Something starting with V. Came in a package with two the first day then one a day for a few (3 to 5 can’t really remember). Later I looked up on the web about the antibiotic and there were many reports saying it was commonly prescribed for bronchitis but that it should not be because bronchitis is almost always viral. I decided that after I read this I did not have confidence in what he was doing.