Protracted Bacterial Bronchitis in Children: Clinical Presentation, Diagnostic Evaluation, and Evidence-Based Management

Protracted bacterial bronchitis (PBB) is a treatable cause of chronic wet cough in children but is frequently missed.Unrecognized children often cycle through repeat asthma treatment, short antibiotic courses that do not address the infection, or open-ended reassurance without further evaluation.This review summarizes the clinical presentation, diagnostic criteria, differential diagnosis, treatment, and follow-up of PBB in children.We conducted a targeted narrative review (PubMed, through September 2026) of clinical trials, longitudinal studies, systematic reviews, and professional-society guidance, distinguishing evidence for antibiotic treatment from limited observational evidence linking recurrent PBB to bronchiectasis.Clinicians should suspect PBB in a child with a daily wet cough lasting more than four weeks and no findings indicating another cause.Resolution after an appropriate antibiotic course supports the diagnosis.Amoxicillinclavulanate remains the usual first-line treatment, typically for two weeks initially, with reassessment and selective extension to four weeks if the child has not cleared.Further investigation is warranted when symptoms persist despite adequate treatment, recurrence is frequent, or specific warning signs appear.In an otherwise typical, treatment-responsive case, bronchoscopy and chest computed tomography (CT) are not routine first steps.Management hinges on recognizing the wet-cough phenotype, giving an adequate therapeutic trial, confirming resolution, and investigating promptly when treatment fails.Antibiotics appear to improve cough resolution, but this rests on a small number of trials with limited certainty, and evidence that treatment itself prevents bronchiectasis remains thin.