DOI: 10.4103/prcm.prcm_9_26 ISSN: 2543-0343

Utility of Inhaled Antibiotics in Children with Exacerbations of Non-Cystic Fibrosis Bronchiectasis: A Pilot Study

Wan Theng Goh, Shih Ying Hng, Mohamad Shafiq Azanan, Kah Peng Eg, Quraisiah Adam, Qiao Yun Lee, Jessie Anne de Bruyne, Anna Marie Nathan
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Abstract

Background:

Inhaled antibiotics are an accepted treatment strategy in cystic fibrosis. We aimed to explore the effect of inhaled antibiotics with and without systemic antibiotics in children experiencing an exacerbation of non-cystic fibrosis bronchiectasis (NCFBE).

Methods:

This prospective pilot study included children with an exacerbation of NCFBE. Inhaled antibiotics were prescribed based on the bacterial antibiogram for 3 months or 1 month if they had a tracheostomy. Systemic antibiotics were prescribed at the physician’s discretion. We assessed respiratory bacterial culture and Parent Cough-specific Quality-of-Life (PC-QoL) and cough scores at recruitment, after 3 months of treatment, and 3 months postcessation of treatment.

Results:

Thirty-seven participants were recruited with a median (interquartile range) age of 3.19 (1.55, 6.74) years. One-quarter ( n = 9, 24.3%) had a tracheostomy; the majority had isolated Pseudomonas aeruginosa (59.5%) and received antibiotics ( n = 28, 75.6%). Bacterial eradication was achieved in 75.7%, with lower eradication rates in children with a tracheostomy (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.05–1.39) and in those treated without systemic antibiotics (OR: 0.24, 95% CI: 0.04–1.50), although these findings were not statistically significant. Significant improvements in PC-QoL scores and cough scores after 3 months of treatment were observed in patients who received both systemic and inhaled antibiotics ( P = 0.002 and P = 0.003, respectively), but not in patients who received inhaled antibiotics alone ( P = 0.09 and P = 0.89, respectively). Bacterial recrudescence occurred in 16.2% ( n = 6) of participants at 3 months postcessation, with P. aeruginosa ( n = 5) being the most common organism, and when systemic antibiotics ( n = 1) were not used.

Conclusion:

Inhaled antibiotics alone are not effective in managing children with exacerbations of NCFBE.

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