Azithromycin in PBB and the microbiome
Research type
Research Study
Full title
Prophylactic azithromycin in paediatric protracted bacterial bronchitis: Effects on the nasal microbiotia and resistome.
IRAS ID
255076
Contact name
Alison Condliffe
Contact email
Sponsor organisation
Sheffield Childrens NHS Foundation Trust
Clinicaltrials.gov Identifier
SCH-2373, Sheffield Children's Hospital reference number
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
Protracted bacterial bronchitis (PBB) has been identified as one of the commonest causes of a chronic wet cough in those referred to paediatric hospital respiratory specialists. This is defined as a wet cough for >4 weeks with no other detectable chronic respiratory disease and response to 14 days of antibiotics. It has been associated with positive bacterial cultures but because of the challenges in obtaining invasive samples in children of this age, the diagnosis is usually made on clinical grounds.\n\nMany of these apparently normal children continue to have pulmonary exacerbations characterised by increased cough and associated with new chest signs such as crackles. Although the natural history of PBB is unclear, recurrent PBB (>3 episodes in a year) has been reported to cause permanent damage to the breathing tubes, a condition known as bronchiectasis. Children who are at risk of developing bronchiectasis, are often prescribed low dose regular ‘prophylactic’ antibiotics to try and reduce infection frequency and hence the risk of airway scarring. There is increasing prophylactic use of an antibiotic called azithromycin, despite the emergence of antimicrobial resistance and increased awareness of antimicrobial stewardship\n\nUntil recently healthy lungs were thought to be sterile, but we now known they harbour a diverse population of colonising organisms (microbiome) that promote respiratory health, and may be adversely affected by the administration of antibiotics. Concurrent changes in the microbial populations of the upper airways (e.g. nasal passages) reflect this. The use of antibiotics needs to be appropriate (to treat bacterial but not viral infections) and sufficient (to reduce risks of airway damage), but we need to understand the impact of prophylactic antibiotics on antimicrobial resistance and changes in the respiratory microbiome.\nThis project aims to investigate both resistance patterns and changes in the nasal microbiome of children prescribed prophylactic azithromycin for PBB.\n
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
19/YH/0207
Date of REC Opinion
27 Jun 2019
REC opinion
Favourable Opinion