• A B Chang, J J Oppenheimer, M Weinberger, B K Rubin, and R S Irwin.
• Chest. 2015 Nov 5.

BackgroundWe undertook systematic reviews to examine key questions (KQs) related to pediatric chronic wet cough. In children with chronic (>4-weeks) wet/productive cough not related to bronchiectasis; (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should they be referred for further investigations?MethodsWe used the CHEST expert cough panel's protocol. Two authors screened searches, selected and extracted data. Systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) and cross-sectional studies published in English were included.ResultsData were presented in PRISMA flowcharts and summaries tabulated. Fifteen studies were included in KQ1 (systematic reviews=3, RCTs=3, prospective studies=5, retrospective studies=4) and 17 in KQ2 (RCT=1, prospective=11, retrospective=5). Combining data from RCTs (KQ1), the number needed to treat for benefit was 3 (95%CI 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent but there were minor variations.ConclusionThere is high quality evidence that in children aged ≤14-years with chronic (>4-weeks duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high quality evidence that when specific cough pointers (e.g. digital clubbing) are present in children with wet cough, further investigations (e.g. flexible bronchoscopy, chest CTs and immunity tests) should be undertaken. When the wet cough does not improve by 4-weeks of antibiotics, there is moderate quality evidence that children should be referred to a major center for consideration of further investigations to determine whether an underlying lung or other disease are present.

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