A lack of data on the use of different antibiotics to treat and/or prevent acute exacerbations in children with bronchiectasis highlights the need for more research in this area, a review study has found.
Titled “Which antibiotics should be used to treat children with an acute exacerbation of bronchiectasis and as long-term prevention of exacerbations?” the review was published in Archives of Disease in Childhood.
Antibiotics are often prescribed for acute exacerbations in bronchiectasis. However, for children with this condition, it is not known if one antibiotic is more effective than another.
Researchers set out to answer this question by analyzing the available scientific literature, but there were few studies that directly addressed this question.
They found two studies that assessed antibiotic use to control exacerbations in children. In one study, 179 children were randomly assigned to treatment with either amoxicillin-clavulanate and placebo, or azithromycin and placebo.
Results showed that exacerbations were resolved for 73 (83.9%) of the 87 children in the amoxicillin group, and 61 (83.6%) of the 73 children in the azithromycin group. Exacerbations were significantly shorter in the amoxicillin group (median of 10 vs. 14 days), but there was no significant difference in terms of efficacy.
In the other study, 153 bronchiectasis patients positive for infection with the bacteria Pseudomonas aeruginosa were randomly selected to receive either nebulized (inhaled) amikacin and intravenous (into the vein) antibiotics, or intravenous antibiotics alone.
The addition of amikacin increased the rate of bacterial eradication (51.4% vs. 23.2%). However, P. aeruginosa infections are relatively rare in bronchiectasis, accounting for only up to 16% of infections. That means any ability to generalize these findings to the bronchiectasis population at large is questionable.
One additional study assessed long-term use of antibiotics to reduce bronchiectasis exacerbations: 89 indigenous Australian, Maori, and Pacific Island children with bronchiectasis or chronic suppurative lung disease were treated with either azithromycin or a placebo for one to two years.
There was a significantly lower frequency of exacerbations in the azithromycin-treated group — but there also was a higher frequency of azithromycin-resistant bacteria detected in these children (46% vs. 11%). Those findings suggest that long-term antibiotic use should be employed with caution so as not to generate treatment-resistant bacteria.
These were the only studies the researchers found that directly examined antibiotic use in children with bronchiectasis. There were a handful of studies in adults, but those results can’t reliably be extrapolated to children. Plus, none of those studies’ results suggested that any one antibiotic might be superior to another in treating exacerbations.
Overall, this paper found some evidence that azithromycin is effective for controlling and/or preventing exacerbations. However, nothing directly suggests that this antibiotic is better or worse than others. This review highlights the need for more studies in antibiotic use for children with bronchiectasis, the researchers said.
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