title: Children With Chronic Wet or Productive Cough--Treatment and Investigations: A Systematic Review.
abstract: BACKGROUND
  Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks' duration) wet or productive cough not related to bronchiectasis: KQ1-How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2-When should they be referred for further investigations?
  
  
  METHODS
  The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English.
  
  
  RESULTS
  Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the 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.
  
  
  CONCLUSIONS
  There 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 (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.
authors.affiliation: Child Health Division, Menzies School of Health Research, Darwin, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland Uni of Technology, Children's Health Queensland, Queensland, Australia. Electronic address: annechang@ausdoctors.net.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ.
authors.forename: John J
authors.initials: JJ
authors.lastname: Oppenheimer
authors.affiliation: Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA.
authors.forename: Miles
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Rubin
authors.affiliation: UMass Memorial Medical Center, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D013183:Sputum
chemical_list: D000900:Anti-Bacterial Agents
keywords: cough; evidence based; systematic review; treatment