Macrolide resistance in children with protracted bacterial bronchitis
Research type
Research Study
Full title
Does prophylactic azithromycin induce macrolide resistance in children with protracted bacterial bronchitis?
IRAS ID
246148
Contact name
Alison Condliffe
Contact email
Sponsor organisation
Sheffield Childrens NHS Foundation Trust
Duration of Study in the UK
1 years, 5 months, 1 days
Research summary
Chronic cough in children is very common. Protracted bacterial bronchitis (PBB) has been identified as the commonest cause of chronic cough in those referred to hospital respiratory specialists for further investigations. PBB is defined as a wet cough for >4 weeks with no other detectable chronic respiratory disease and response to 14 days of antibiotics. The diagnosis is usually made on clinical grounds.
Many of these apparently normal children continue to have pulmonary exacerbations characterised by increased cough, volume of sputum 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 tube (airways) – a condition known as bronchiectasis. This makes these children more susceptible to respiratory infections and predisposes them to an increased risk of premature death.
Children who are at risk of developing bronchiectasis, are often prescribed low dose regular ‘prophylactic’ antibiotics (especially over the winter months) to try and reduce infection frequency and hence the risk of airway scarring. There is little or no data regarding the use of prophylactic antibiotic use in children with PBB.
Long-term antibiotic use suppresses but does not eliminate all bacteria. Such children are vulnerable to persistent infections that become resistant to the antibiotic being used. The use of antibiotics needs to be appropriate (to treat bacterial but not viral infections) and sufficient (to reduce risks of airway damage).
To investigate the impact of prophylactic azithromycin with regards to potential antibiotic resistance, we propose a prospective observational pilot-study in children at Sheffield Children’s Hospital with PBB who have not previously received antibiotic prophylaxis. Participants will have five nasopharyngeal swabs taken over a one-year period looking for antibiotic resistance. The study is being funded by the charity Antibiotic Research UK.
REC name
West of Scotland REC 3
REC reference
18/WS/0176
Date of REC Opinion
1 Oct 2018
REC opinion
Further Information Favourable Opinion