A new study published in The Lancet. Respiratory Medicine was based on the hypothesis that oral amoxicillin-clavulanate and azithromycin would each be superior to placebo in achieving symptom resolution of non-severe exacerbations in children, when administered for 14 days.This was a multicenter, three-arm, parallel, double-dummy, double-blinded, randomized placebo-controlled trial conducted at four pediatriccenters in Australia and New Zealand. The study recruited children aged 1-18 years, with CT-confirmed bronchiectasis unrelated to cystic fibrosis, who had had at least two respiratory exacerbations in the 18 months before study entry. Participants were allocated (ratio - 1:1:1) at exacerbation onset to receive either oral suspensions of amoxicillin-clavulanate (45 mg/kg per day) plus placebo azithromycin, azithromycin (5 mg/kg per day) plus placebo amoxicillin-clavulanate or both placebos for 14 days. Overall, 252 children were enrolled. Respiratory viruses were identified in 53% of the 154 children with available nasal swabs on day 1 of treatment. By day-14, exacerbations had resolved in 65%children in the amoxicillin-clavulanate group; 61% in the azithromycin group; and 43% in the placebo group. When compared to placebo, the relative risk for resolution by day-14 was 1•50 in the amoxicillin-clavulanate group and 1•41 in the azithromycin group. On the other hand, adverse events were recorded in 30% children in the amoxicillin-clavulanate group, 30% in the azithromycin groupand 21% in the placebo group, but no events were severe or life-threatening.From the results, it was concluded that amoxicillin-clavulanate treatment is beneficial in terms of resolution of non-severe exacerbations of bronchiectasis in children, and should remain the first-line oral antibiotic in this setting.
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