Effective Treatment of Acute Bronchitis in Children: How IV Azithromycin Helped a Young Patient Recover from Fever and Cough

Case Overview: A 4-Year-Old Boy Successfully Treated for Mycoplasma-Induced Acute Bronchitis

Two weeks prior to hospitalization, a 4-year-old male patient began experiencing throat irritation, followed by persistent coughing and fever. Initially treated at another medical facility with oral cefaclor granules for two days, his symptoms showed no improvement. He was then referred to Henan Provincial People's Hospital for further evaluation and care. Comprehensive diagnostic testing—including blood work, chest X-ray, and mycoplasma antibody screening—confirmed acute bronchitis caused by Mycoplasma pneumoniae. The child received intravenous azithromide therapy combined with supportive treatments such as oxygen supplementation and rest over a 12-day inpatient period. By the end of treatment, all symptoms had resolved completely, vital signs normalized, and the patient made a full recovery.

Patient Profile and Clinical Summary

Patient: Male, age 4

Diagnosis: Acute bronchitis due to Mycoplasma infection

Hospital: Henan Provincial People's Hospital

Date of Admission: March 2022

Treatment Plan: Intravenous azithromycin + supportive care (oxygen therapy, bed rest)

Duration of Treatment: 12 days of in-hospital care

Outcome: Complete resolution of symptoms, normal body temperature restored, discharged in stable condition

Initial Assessment and Diagnosis

Upon arrival at our clinic, the parents reported that their son had developed an itchy throat about two weeks earlier. This progressed into frequent coughing and a high-grade fever within several days. Despite taking cefaclor—a common antibiotic—for two days under previous medical advice, there was no noticeable improvement in his condition. Given the persistence and worsening of respiratory symptoms, we suspected acute bronchial inflammation and admitted the child for thorough assessment.

A detailed history and physical examination were conducted. Based on clinical presentation—prolonged cough, low-grade fever, and mild respiratory distress—we considered infectious bronchitis as the primary diagnosis. To confirm this, we initiated a series of laboratory and imaging tests to rule out other potential causes and identify the underlying pathogen.

Diagnostic Findings and Confirmation of Mycoplasma Infection

Comprehensive evaluations were performed upon admission:

Blood tests: Revealed decreased white blood cell count, reduced neutrophils and hemoglobin levels, and elevated lymphocyte counts—indicative of a viral or atypical bacterial infection.
Chest X-ray: Showed increased and disordered lung markings bilaterally, consistent with bronchial inflammation.
Mycoplasma IgM Antibody Test: Came back positive, confirming recent Mycoplasma pneumoniae infection—the most common cause of atypical pneumonia and bronchitis in young children.

With these findings, we established a definitive diagnosis of acute bronchitis secondary to Mycoplasma pneumoniae. We discussed the results thoroughly with the family, explaining the nature of the infection and the rationale behind choosing intravenous azithromycin as the cornerstone of treatment.

Treatment Strategy: Targeted Antibiotic Therapy with Supportive Care

Given the confirmed mycoplasma etiology, oral antibiotics like penicillins or cephalosporins (e.g., cefaclor) are typically ineffective because mycoplasma lacks a cell wall. Instead, macrolide antibiotics such as azithromycin are the preferred choice due to their ability to inhibit protein synthesis in atypical bacteria.

The patient was started on intravenous azithromycin once daily. As a semi-synthetic macrolide, azithromycin offers several advantages:

Rapid onset of action
Long tissue half-life allowing sustained antibacterial effect
High penetration into lung tissues and alveolar macrophages
Excellent efficacy against Mycoplasma, Chlamydophila, and other atypical pathogens

In addition to antibiotic therapy, the child received supportive care including supplemental oxygen to maintain adequate saturation, hydration support, and enforced rest to reduce metabolic demand and promote healing.

Progress and Recovery Timeline

The therapeutic response was closely monitored throughout the 12-day hospital stay:

Day 1–3: Early Improvement

Within the first 24 hours of IV azithromycin administration, the frequency and intensity of coughing began to decrease. By day three, the child's temperature returned to normal (36.8°C–37.2°C), and productive cough diminished significantly, indicating reduced airway inflammation and clearing of infection.

Day 4–7: Marked Symptom Relief

By the seventh day, the boy exhibited only occasional dry coughs, primarily in the morning. Breath sounds improved on auscultation, and energy levels increased. Parents noted better sleep quality and appetite return, signaling systemic recovery.

Day 8–12: Final Stages and Discharge Preparation

On day 12, follow-up blood tests showed complete normalization of hematological parameters. Chest imaging demonstrated resolution of inflammatory changes. With no residual fever, cough, or breathing difficulties, and after consulting with the family, we approved discharge with instructions for continued home care and outpatient monitoring.

Post-Discharge Guidance for Long-Term Wellness

While the immediate infection was successfully treated, preventing recurrence is equally important—especially in young children whose immune systems are still developing. I advised the parents on key lifestyle and preventive measures:

Temperature Regulation: Dress the child appropriately during seasonal transitions and cold nights to avoid sudden exposure to cold air, which can trigger airway irritation.
Nutrition: Emphasize a balanced diet rich in fresh fruits, vegetables, lean proteins, and whole grains. Avoid spicy, greasy, or overly processed foods that may weaken immunity or exacerbate mucus production.
Sleep & Activity Balance: Ensure consistent sleep schedules and limit excessive physical activity until full strength returns. Overexertion can delay recovery and increase susceptibility to reinfection.
Hygiene Practices: Encourage regular handwashing and minimize contact with sick individuals, especially during peak cold and flu seasons.

Clinical Reflection: Why Prompt and Accurate Treatment Matters

This case highlights the importance of accurate diagnosis in pediatric respiratory illnesses. Many parents may assume that any cough or fever can be managed with standard antibiotics—but when the culprit is an atypical organism like Mycoplasma pneumoniae, conventional treatments often fail. Misdiagnosis or delayed intervention can lead to prolonged illness or complications such as pneumonia or bronchiolitis.

Early recognition of atypical symptoms—such as persistent dry cough without prominent nasal congestion, slow response to beta-lactam antibiotics, and subtle radiographic changes—is crucial. Utilizing targeted diagnostics and appropriate antimicrobial selection, such as intravenous azithromycin in severe cases, ensures faster recovery and reduces the risk of transmission in community settings like schools and daycare centers.

Final Thoughts

Acute bronchitis is common in children, but its management requires precision. When symptoms persist beyond a few days despite initial treatment, seeking expert medical evaluation is essential. With timely diagnosis, evidence-based therapies like IV azithromycin, and comprehensive supportive care, even severe cases can result in full recovery—just as we saw in this young patient. Parents should remain vigilant, trust clinical guidance, and prioritize both treatment and prevention for optimal long-term health outcomes.