Abstract
Aims: To determine how respiratory pediatricians across Australia and New Zealand prescribe azithromycin for children with chronic wet cough, including recurrent protracted bacterial bronchitis, chronic suppurative lung disease (CSLD) and bronchiectasis.Methods: A prospective web-based questionnaire was emailed to members of the Pediatric Special Interest Group of the Thoracic Society of Australia and New Zealand (TSANZ) between April and May 2018. It comprised eight demographic and 15 clinically focused questions.Results: Of the 73 respiratory pediatricians listed across Australia and New Zealand, 29 (40%) responded and all prescribed azithromycin for chronic wet cough. Twelve (41%) indicated that they would consider prescribing a short-course (2–4 weeks) of azithromycin for children with a chronic wet cough. Although most respondents reported prescribing long-term (>4-weeks) azithromycin for either CSLD (n = 23, 79%) or bronchiectasis (n = 24, 83%), only nine (31%) respondents would commence treatment if in the previous 12-months these children experienced three non-hospitalized exacerbations and just 12 (41%) would do so if there had been two hospitalisations for severe exacerbations during the same period in accordance with the TSANZ national guidelines. A lower threshold for prescribing azithromycin was described for Indigenous children or if co-morbidities were present. None prescribed azithromycin for >24-months. Macrolide-resistance was reported in Streptococcus pneumoniae and Staphylococcus aureus.Conclusion: Although Australian and New Zealand respiratory pediatricians in this survey prescribed azithromycin for chronic wet cough most often in children with either CSLD or bronchiectasis, many did so outside the current national guidelines. Reasons for this need exploring.
Highlights
Chronic (>4-weeks) wet cough accompanied by bacterial infection and neutrophilic infiltration of the lower airways are common clinical features of endobronchial suppuration present in protracted bacterial bronchitis (PBB), recurrent protracted bacterial bronchitis, chronic suppurative lung disease (CSLD), and bronchiectasis
Respondents came from New Zealand and all Australian states/territories other than Tasmania, with the greatest number practicing in Queensland (9/29, 31%)
Azithromycin was prescribed by all 29 respondents with 14 (48%) using this antibiotic to treat >25 children for a chronic wet cough in the previous 12-months
Summary
Chronic (>4-weeks) wet cough accompanied by bacterial infection and neutrophilic infiltration of the lower airways are common clinical features of endobronchial suppuration present in protracted bacterial bronchitis (PBB), recurrent protracted bacterial bronchitis (rPBB), chronic suppurative lung disease (CSLD), and bronchiectasis. They form a continuum of increasing severity and are being recognized increasingly in children worldwide, [1] especially among disadvantaged Indigenous populations [2]. The macrolide, azithromycin, is a potentially attractive option for treating patients with a chronic wet cough It is well-tolerated, has good oral bioavailability and a prolonged half-life allowing convenient once-daily or even one-to three times weekly dosing [4]. Azithromycin induces macrolide resistance amongst commensal and pathogenic organisms, which may have adverse effects at a personal health and population-level [6]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call