Azithromycin is an attractive alternative to amoxicillin-clavulanate for the management of non-severe acute exacerbations of bronchiectasis in children but should be reserved as a second-line therapy in accordance with Australian and New Zealand guidelines.
Dr Vikas Goyal, from the Department of Respiratory and Sleep Medicine at the Queensland Children’s Hospital, told the 2019 ERS Congress that the findings from a novel three-arm RCT support the guidelines.
The study compared 14 days of either treatment with placebo in 252 children with CT-proven bronchiectasis across four paediatric centres in Australian and New Zealand.
By day 14, the acute exacerbations had resolved in 65% of children in the amoxicillin–clavulanate group, 61% in the azithromycin group, and 43% in the placebo group.
The number needed to treat for benefit was five for amoxicillin-clavulanate and six for azithromycin.
The median time to resolution was seven days with amoxicillin-clavulanate, eight days with azithromycin and 10 days with placebo.
Due to the design of the study, the p value for statistical significance was lowered to p=0.025, resulting in a significant effect of amoxicillin-clavulanate compared to placebo (p=0.015) but not azithromycin (p=0.042).