Daughter's bronchitis won't respond to antibiotics


November 23, 1993|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,Contributing Writers

Q: My daughter has had three episodes of bronchitis this year which didn't seem to respond to antibiotics. She usually starts with a cold and then it settles into her chest with a cough and chest tightness. Why don't antibiotics help her? Could she be immune to them?

A: We suspect your daughter is probably quite all right although we don't have all the information necessary to reassure you completely. As a first step, let us try to define precisely the word bronchitis, which means different things to different people. Strictly speaking, the word indicates inflammation (itis) of the bronchi (the large air passages that lead from the windpipe down into the lungs).

In otherwise healthy, nonsmoking children and adolescents, bronchitis almost always is caused by viral infection and will not respond to antibiotics. If your daughter didn't respond to antibiotics, it is likely that she had this uncomplicated bronchitis which must run its course. In a small percentage of children, such as those with lung conditions like cystic fibrosis, treatment of bronchitis with antibiotics may help. The same may be true for teen-agers who smoke cigarettes: Their bronchi are damaged by the smoke and are prone to secondary infection with bacteria following a simple viral infection.

We can think of another potential explanation for you daughter's symptoms and lack of response to antibiotics. It may be that she has a mild form of asthma and that the colds she gets trigger her asthma. This would explain her symptoms of cough and chest tightness, both features of an asthma attack. Since asthma is largely caused by inflammation, she would not respond to antibiotics. However, there are a number of excellent medications available for treatment of asthma and you should check with her doctor about them. Mold asthma is quite common, but often is misdiagnosed as recurrent episodes of bronchitis.

You raise the question of her becoming immune to antibiotics, a concern expressed frequently by parents. Individuals do not become immune to these medications. Rather, frequent use of an antibiotic by an individual helps select out bacteria in the body that have, over time, developed a resistance to the antibiotic. Subsequent use of that same antibiotic will, therefore, have no effect. That is why physicians try to limit use of


Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center. Dr. Joffe is director of adolescent medicine.

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