Prophylactic azithromycin in pre-schoolers with chronic respiratory symptoms: a longitudinal survey

Abstract

Objectives:   Long-term prophylactic azithromycin (AZM) is used in daily practice in children with chronic respiratory symptoms because of its immunomodulatory and anti-inflammatory properties. No substantial scientific evidence is available for the population without underlying condition. The objective of this study is to test if prophylactic azithromycin has an effect on respiratory outcomes in preschool non-cystic fibrosis (CF) children with chronic respiratory symptoms. As secondary outcomes the evolution of body mass index Z-scores, as a measure of overall health, and respiratory tract cultures were studied.
Study design: Non-CF-children between one and six years old with chronic respiratory symptoms, treated with prophylactic AZM were included in this retrospective analysis. The number of respiratory exacerbations and body mass index Z-scores one year before and one year after the start of AZM were compared. The nature of the respiratory disease, reason for discontinuing AZM and respiratory microbiological profiles were studied.
Results: 35 children were included. A significant reduction in the number of exacerbations was observed, both in the entire population (p=0.00004) and in the subgroup of children (n=14) without an underlying condition (p=0.002). No significant difference in body mass index Z-scores and respiratory microbiological profiles was seen. However, a non-significant increase (p=0.188) in macrolide-resistant bacterial infections was observed.
Conclusion: Prophylactic AZM may decrease the number of exacerbations in non-CF pre-schoolers with chronic respiratory symptoms. However, the increased bacterial macrolide-resistance requires further evaluationa