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Duration of amoxicillin-clavulanate for protracted bacterial bronchitis in children: a randomized controlled trial

conference contribution
posted on 2023-06-09, 23:57 authored by Thomas RufflesThomas Ruffles, Vikas Goyal, Julie Marchant, Brent Masters, Stephanie Yerkovich, Helen Buntain, Anne Cook, Andre Schultz, Lesley Versteegh, Anne Chang
Introduction: The optimal duration of antibiotic treatment for children with protracted bacterial bronchitis (PBB), a common cause of chronic wet cough in children, is controversial. Effective management may reduce the risk of chronic suppurative disease (e.g. bronchiectasis). Objective: To determine whether 4-wks of amoxicillin-clavulanate is superior to 2-wks for improved clinical outcomes in children with suspected PBB. Methods: Multi-center, double-blind, placebo-controlled, RCT in Australian children aged 2-mo to 19-yrs with suspected PBB. Children were randomized to either 4-wks of amoxicillin-clavulanate or 2-wks of amoxicillin-clavulanate followed by 2-wks placebo. Follow-up was for 6-mo. Our primary outcome was cough resolution within 28-days. Recurrence of PBB, parent-proxy cough specific quality of life (PC-QoL) score at 28-days and time to first exacerbation were secondary outcomes. Results: 106 children were randomized, median age 2.0-yrs. There was no difference in cough resolution by 28-days between the groups (4-wks=61.5% vs 2-wks=71.4%) (RR 0.87, 95% CI0.59-1.29; p=0.50). Longer antibiotic treatment resulted in a non-significant increase in time to next wet cough exacerbation (150-wks vs 48-wks; p=0.094) and reduced PBB recurrence (74% vs 53%; p=0.074) in those whose cough resolved by day-28. PC-QoL improved by a median of 2.0 across both groups. Conclusion: A 4-wk course of amoxicillin-clavulanate in children with suspected PBB confers little advantage compared to a 2-wk course. A non-inferiority RCT is required to support our findings but until such data is available, children suspected of having PBB should be treated with the current standard 2-wks.

History

Publication status

  • Published

Journal

European Respiratory Journal

ISSN

0903-1936

Publisher

European Respiratory Society

Issue

64

Volume

56

Article number

a4131

Event name

The European Respiratory Society (ERS) conference

Event type

conference

Event date

07 September 2020

Series

ERS International Congress

Department affiliated with

  • Clinical and Experimental Medicine Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2021-06-28

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