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Azithromycin for chest infections in severe CP?

22 Oct, 07 | by BMJ

Is the frequency of recurrent chest infections, in children with chronic neurological problems, reduced by prophylactic Azithromycin?
You see Jonny, an 8 yr old boy with severe dystonic CP as a result of his premature birth at 26 wks gestation with another chest infection. He is mainly gastrostomy fed and had a Nissen’s fundoplication 5 yrs ago at the same time his gastrostomy was inserted. He has copious secretions and a poor cough reflex; these are made worse by Nitrazepam he requires for his dystonia. Evidence from previous barium studies and swallow assessments show that he chronically aspirates his secretions. He has no symptoms of upper airway obstruction. He has had increasingly frequent lower respiratory tract infections over the last year, requiring admission and intra-venous antibiotics (a total of four times in 2006). His weight and height have fallen from the 10th to the 3rd percentile. A chest x-ray shows chronic changes suggestive of underlying bronchiectasis. Immune function and Sweat test are normal. He awaits a CT scan. He has daily physiotherapy and regular suction and usually produces copious muco-purulent secretions. He is on maximal anti-reflux medication already. Would prophylactic Azithromycin reduce his risk of further LRTI? Or might it increase growth of multi resistant organisms within his sputum?

Structured Clinical Question

Do children with chronic lung disease (not Broncho-pulmonary Dysplasia) and/or bronchiectasis (subject), who are prescribed long term azithromycin as prophylaxis (intervention) have a reduction in frequency of respiratory exacerbations (outcome) without a change in the bacterial flora found on sputum culture (outcome).

The answer isn’t as straightforward as it seems: read here.

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  • Clive

    Azithromycin has several potential benefits in terms of it’s anti-inflammatory as well as anti-infective properties however the quality of evidence to support it’s use in this type of patients is limited to a non placebo controlled study (Thorax 59(4) p590-1). Interestingly it might have a role in primary prevention (Respir Res 2007; 5:8:41).
    I’m not aware of any data looking at adverse effects such as selection of antibiotic resistance. I presume this child is vaccinated against Strep. pneumoniae (and receives seasonal flu jabs).
    ARCHI ADDS: The cases are all amalgams of various individuals, and as such do not refer to a single individual. The point about vaccination for this type of patients is well made.

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