Scientific Letter
Protracted bacterial bronchitis: a condition to be considered in children
Bronquitis bacteriana persistente, una entidad a considerar en pediatría
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Bubbles are trapped in the narrow peripheral portal vessels and can be visualized, even if gas is not moving during performance of the ultrasound. Intestinal pneumatosis appearing as isolated foci (C) or clustered foci in the bowel loop walls (D). (Appendix B, supplemental material, video.)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Oulego-Erroz, Sandra Terroba-Seara, Paula Alonso-Quintela, Aquilina Jiménez-Gónzález, Erick Ardela-Díaz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Oulego-Erroz" ] 1 => array:2 [ "nombre" => "Sandra" "apellidos" => "Terroba-Seara" ] 2 => array:2 [ "nombre" => "Paula" "apellidos" => "Alonso-Quintela" ] 3 => array:2 [ "nombre" => "Aquilina" "apellidos" => "Jiménez-Gónzález" ] 4 => array:2 [ "nombre" => "Erick" "apellidos" => "Ardela-Díaz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320300394" "doi" => "10.1016/j.anpedi.2020.01.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320300394?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287920301952?idApp=UINPBA00005H" "url" => "/23412879/0000009300000006/v2_202105090744/S2341287920301952/v2_202105090744/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Protracted bacterial bronchitis: a condition to be considered in children" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "413" "paginaFinal" => "415" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Víctor Fernández Ventureira, César García Vera" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Víctor" "apellidos" => "Fernández Ventureira" "email" => array:1 [ 0 => "vfernandezventureira@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "César" "apellidos" => "García Vera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud José Ramón Muñoz Fernández, Servicio Aragonés de Salud, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bronquitis bacteriana persistente, una entidad a considerar en pediatría" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory tract infections are the most frequent presenting complaint in primary care. Although it is usually an unimportant manifestation in the paediatric population, cough, when persistent, generates anxiety in patients and their families, leading to a significant consumption of health care resources.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some case series in the literature that include hospitalised patients had led to the hypothesis that protracted bacterial bronchitis (PBB) could be the leading cause of chronic cough in preschool-aged children (up to 40% of cases).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4–6</span></a> Although PBB has been established as a clinical entity only recently (2006), similar presentations have been described for decades under the label of “chronic bronchitis of childhood”.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There is a low awareness of this disease in our country, and it used to not be included in the differential diagnosis of chronic cough, either due to underdiagnosis, inadequate treatment or a lower actual incidence than described in the primary care setting.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of the cases of 3 patients with suspected PBB managed in a paediatric primary care clinic in Zaragoza (serving 1415 children aged 0–14 years) between September 2018 and September 2019. Our main objective was to increase awareness in clinicians of a disease defined only recently and for which there is a low level of suspicion in everyday clinical practice.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>. Girl aged 5 years with a history of bronchial hyperresponsiveness undergoing treatment with montelukast, that developed a persistent wet cough in the context of cold symptoms. The salient findings of the physical examination were diffuse expiratory wheezing in absence of breathing difficulty or hypoxaemia, leading to initiation of treatment with inhaled salbutamol and oral steroids, which did not improve symptoms. Poorly controlled asthma was suspected, so inhaled budesonide was added for maintenance therapy. The chest radiograph was normal. Given the persistence of the cough at 40 days from onset, a course of oral treatment with amoxicillin-clavulanic acid was prescribed, which achieved resolution of symptoms within 48<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2</span>. Boy aged 4 years with a history of bronchial hyperresponsiveness currently treated with inhaled budesonide that had onset with persistent wet cough in the context of a febrile cold-like illness. The main findings of the examination were diffuse wheezing and rhonchi in the absence of alarming signs. The initial treatment was inhaled salbutamol combined with an oral corticosteroid, with addition of azithromycin at a later time due to the lack of improvement. The chest radiograph was normal. On account of the persistence of the wet cough for 4 weeks, amoxicillin-clavulanic acid was added, which achieved an improvement in symptoms in the first 24<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 3</span>. Girl aged 2 years with a history of bronchial hyperresponsiveness that developed a persistent wet cough in the context of a respiratory tract infection treated with inhaled salbutamol, an oral antihistamine (springtime) and an oral corticosteroid, without a favourable response. Maintenance therapy with inhaled budesonide was initiated due to the persistence of the cough. Since the patient did not improve in the 5 weeks that followed, amoxicillin-clavulanic acid was added, with evidence of clinical improvement within a few days (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Protracted bacterial pneumonia refers to a chronic infection of the lower respiratory tract manifesting as wet or productive cough lasting more than 4 weeks that resolves with antibiotic treatment in the absence of another diagnosis. Although it may appear at any age, its incidence is highest in children aged less than 6 years.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The aetiology of PBB is unknown, but it is associated with abnormalities of mucociliary clearance, immune defects, structural anomalies and the formation of bacterial biofilms. The main causative agents are nontypeable <span class="elsevierStyleItalic">Haemophilus influenzae</span>, <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> and, less frequently, <span class="elsevierStyleItalic">Moraxella catarrhalis.</span><a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Its natural history consists of onset with cold-like symptoms and a lower respiratory tract infection that resolve spontaneously with the exception of an isolated persistent wet cough. The findings of the physical examination, imaging tests and pulmonary function tests are normal or nonspecific. Its manifestations may be confused with asthma, and up to 30% of cases occur in asthmatic patients who will not improve until the infection is treated appropriately.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The differential diagnosis should include rhinosinusitis, although the persistence of abnormal breath sounds on auscultation supports the diagnosis of PBB.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The criteria applied for diagnosis were presence of wet cough of more than 4 weeks’ duration with isolation of a bacterial pathogen from bronchoalveolar lavage with more than 10<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> colony-forming units, absence of evidence of concomitant infection by <span class="elsevierStyleItalic">Bordetella pertussis</span> or <span class="elsevierStyleItalic">Mycoplasma pneumoniae,</span> and resolution of symptoms within 2 weeks with oral antibiotherapy. Since a flexible bronchoscopy examination is not indicated routinely in children presenting with wet cough, we substituted this test by noting the absence of other signs and symptoms associated with chronic cough, such as dyspnoea, haemoptysis and chest pain.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The recommended antibiotic treatment is amoxicillin-clavulanic acid for a minimum of 2 weeks, which may be prolonged to up to 4–6 weeks in some children. Some of the proposed alternative treatments include cephalosporins, trimethoprim, sulfamethoxazole or macrolides.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The response to treatment is very good and should be considered confirmation of the diagnosis. However, recurrences are frequent (in up to 25% of cases) and may require several courses of antibiotherapy. A poor response or recurrent episodes require ruling out other diseases. There are similarities between PBB, suppurative lung disease and bronchiectasis, which could be conceived of as different stages in a spectrum of airway disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, PBB should be considered in children presenting with chronic wet cough in absence of clinical or radiological signs suggestive of a different diagnosis. However, the clinical criteria must be applied very strictly and accurately, given their nonspecificity, to prevent unnecessary use of antibiotics and the associated emergence of drug resistance (in our clinic, the criteria were only met by 3 patients out of a caseload of 1415 children in the course of 1<span class="elsevierStyleHsp" style=""></span>year).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-27" "fechaAceptado" => "2020-01-21" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Ventureira VF, Vera CG. Bronquitis bacteriana persistente, una entidad a considerar en pediatría. An Pediatr (Barc). 2020;93:413–415.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Personal history of asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung auscultation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse expiratory wheezing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse wheezing and rhonchi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse rhonchi \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest radiography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Montelukast<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled corticosteroid<span class="elsevierStyleSup">a</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled corticosteroid<span class="elsevierStyleSup">a</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled corticosteroid<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled salbutamol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled salbutamol \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral corticosteroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral corticosteroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral corticosteroid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inhaled salbutamol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to initiation of antibiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to resolution of symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤ 48 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤ 24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤ 48 h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic regimen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin-clavulanic acid 8:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin-clavulanic acid 8:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin-clavulanic acid 8:1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80<span class="elsevierStyleHsp" style=""></span>mg/kg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80<span class="elsevierStyleHsp" style=""></span>mg/kg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80<span class="elsevierStyleHsp" style=""></span>mg/kg/day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 doses/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 doses/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 doses/day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 months \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2591863.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Maintenance therapy.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of the characteristics of the presented cases.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ERS statement on protracted bacterial bronchitis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kantar" 1 => "A.B. Chang" 2 => "M.D. Shields" 3 => "J.M. Marchant" 4 => "K. Grimwood" 5 => "J. Grigg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Eur Respir J." "fecha" => "2017" "volumen" => "50" "paginaInicial" => "1602139" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An underestimated cause of chronic cough: the protracted bacterial bronchitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Di Filippo" 1 => "A. Scaparrotta" 2 => "M.I. Petrosino" 3 => "M. Attanasi" 4 => "S. Di Pillo" 5 => "F. Chiarelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/atm.ATM_12_17" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Med" "fecha" => "2018" "volumen" => "13" "paginaInicial" => "7" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29387250" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tos húmeda: bronquitis bacteriana persistente, enfermedad supu-rativa bronquial y bronquiectasias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.M. Busquets Monge" 1 => "S. Castillo Corullón" 2 => "A.J. Aguilar Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Protoc Diagn Ter Pediatr." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 35 | 7 | 42 |
| 2024 October | 173 | 54 | 227 |
| 2024 September | 189 | 62 | 251 |
| 2024 August | 217 | 94 | 311 |
| 2024 July | 186 | 38 | 224 |
| 2024 June | 173 | 34 | 207 |
| 2024 May | 143 | 45 | 188 |
| 2024 April | 140 | 48 | 188 |
| 2024 March | 143 | 32 | 175 |
| 2024 February | 138 | 37 | 175 |
| 2024 January | 243 | 28 | 271 |
| 2023 December | 140 | 59 | 199 |
| 2023 November | 147 | 64 | 211 |
| 2023 October | 134 | 38 | 172 |
| 2023 September | 125 | 42 | 167 |
| 2023 August | 84 | 17 | 101 |
| 2023 July | 118 | 49 | 167 |
| 2023 June | 105 | 45 | 150 |
| 2023 May | 130 | 36 | 166 |
| 2023 April | 82 | 20 | 102 |
| 2023 March | 112 | 49 | 161 |
| 2023 February | 80 | 23 | 103 |
| 2023 January | 103 | 29 | 132 |
| 2022 December | 106 | 44 | 150 |
| 2022 November | 123 | 43 | 166 |
| 2022 October | 122 | 67 | 189 |
| 2022 September | 111 | 39 | 150 |
| 2022 August | 105 | 63 | 168 |
| 2022 July | 96 | 51 | 147 |
| 2022 June | 83 | 27 | 110 |
| 2022 May | 102 | 44 | 146 |
| 2022 April | 128 | 53 | 181 |
| 2022 March | 162 | 56 | 218 |
| 2022 February | 180 | 34 | 214 |
| 2022 January | 80 | 46 | 126 |
| 2021 December | 92 | 37 | 129 |
| 2021 November | 92 | 51 | 143 |
| 2021 October | 112 | 89 | 201 |
| 2021 September | 74 | 38 | 112 |
| 2021 August | 106 | 55 | 161 |
| 2021 July | 88 | 33 | 121 |
| 2021 June | 128 | 35 | 163 |
| 2021 May | 111 | 56 | 167 |
| 2021 April | 198 | 115 | 313 |
| 2021 March | 109 | 50 | 159 |
| 2021 February | 61 | 29 | 90 |
| 2021 January | 74 | 34 | 108 |
| 2020 December | 78 | 26 | 104 |
| 2020 November | 42 | 25 | 67 |
| 2020 October | 7 | 6 | 13 |
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