Efficacy of oral amoxicillin–clavulanate or azithromycin for non-severe respiratory exacerbations in children with bronchiectasis (BEST-1): a multicentre, three-arm, double-blind, randomised placebo-controlled trial

Publication date: Available online 16 August 2019Source: The Lancet Respiratory MedicineAuthor(s): Vikas Goyal, Keith Grimwood, Robert S Ware, Catherine A Byrnes, Peter S Morris, I Brent Masters, Gabrielle B McCallum, Michael J Binks, Heidi Smith-Vaughan, Kerry-Ann F O'Grady, Anita Champion, Helen M Buntain, André Schultz, Mark Chatfield, Paul J Torzillo, Anne B ChangSummaryBackgroundBronchiectasis guidelines recommend antibiotics for the treatment of acute respiratory exacerbations, but randomised placebo-controlled trials in children are lacking. We hypothesised that oral amoxicillin–clavulanate and azithromycin would each be superior to placebo in achieving symptom resolution of non-severe exacerbations in children by day 14 of treatment.MethodsIn this multicentre, three-arm, parallel, double-dummy, double-blind, randomised placebo-controlled trial at four paediatric centres in Australia and New Zealand, we enrolled children aged 1–18 years with CT-confirmed bronchiectasis unrelated to cystic fibrosis, who were under the care of a respiratory physician and who had had at least two respiratory exacerbations in the 18 months before study entry. Participants were allocated (1:1:1) at exacerbation onset to receive oral suspensions of amoxicillin–clavulanate (45 mg/kg per day) plus placebo azithromycin, azithromycin (5 mg/kg per day) plus placebo amoxicillin–clavulanate, or both placebos for 14 days. An independent statistician prepared a computer...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research

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ConclusionsNutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies exami...
Source: Journal of the Academy of Nutrition and Dietetics - Category: Nutrition Source Type: research
Parents of children with the condition flew 7,300 miles to buy a "life-saving" drug unavailable on the NHS in England.
Source: BBC News | Health | UK Edition - Category: Consumer Health News Source Type: news
Conclusions: Using modified serum lab thresholds, addition of liver fibrosis indices, and/or abdominal US can increase detection of liver nodularity in CF. A combination of GGT, GPR, and APRI can help direct which CF children should undergo US evaluation. These tools may improve earlier identification of fibrosis and/or cirrhosis in CF patients.
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
No abstract available
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Invited Commentaries Source Type: research
Publication date: Available online 20 September 2019Source: Journal of Thermal BiologyAuthor(s): Waliullah Masroor, Emilie Farcy, Eva Blondeau-Bidet, Alexander Venn, Eric Tambutté, Catherine Lorin-NebelAbstractThe responses of European sea bass to temperature increase and salinity decrease were investigated measuring mRNA expression levels of main genes involved in ion transport. Juvenile fish were pre-acclimated to seawater (SW) at 18 °C (temperate) or 24 °C (warm) for two weeks and then transferred for two weeks to either fresh water (FW) or SW at the respective temperature. Unlike temperate conditions...
Source: Journal of Thermal Biology - Category: Biology Source Type: research
Abstract The diagnosis of exocrine pancreatic insufficiency (EPI) can be difficult, as symptoms may be nonspecific. A delayed diagnosis of EPI can negatively impact health through poor weight gain, impaired growth, and malabsorption of nutrients. Because of active growth and development, children are more vulnerable to the consequences of untreated EPI. Pancreatic enzyme replacement therapy is the cornerstone of management and offers both symptomatic relief and improvement in clinical outcomes. Additionally, a high-energy diet with unrestricted fat and supplementation with fat-soluble vitamins is often required to...
Source: Nutrition in Clinical Practice - Category: Nutrition Authors: Tags: Nutr Clin Pract Source Type: research
Authors: McElvaney OJ, Wade P, Murphy M, Reeves EP, McElvaney NG Abstract Introduction: The major cause of morbidity and mortality in patients with cystic fibrosis (CF) is lung disease. Inflammation in the CF airways occurs from a young age and contributes significantly to disease progression and shortened life expectancy. Areas covered: In this review, we discuss the key immune cells involved in airway inflammation in CF, the contribution of the intrinsic genetic defect to the CF inflammatory phenotype, and anti-inflammatory strategies designed to overcome what is a critical factor in the pathogenesis of CF lung d...
Source: Expert Review of Respiratory Medicine - Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research
Polymyxins, namely colistimethate sodium (colistin or polymyxin E) and polymyxin B, are used for multi-drug resistant gram-negative bacterial infections, including Pseudomonas aeruginosa and Acinetobacter baumannii 1. As treatments and therapy have advanced, patients with cystic fibrosis are living longer. However, these patients have high exposure to intravenous antibiotics, most commonly penicillins, cephalosporins, and aminoglycosides. With colonization or infections with resistant gram-negative bacilli, the exposure to antibiotics broadens to include the polymyxins.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research
Conclusions: The 6-min walk test is a reproducible and reliable tool to measure exercise tolerance for children and adolescents with cystic fibrosis. The minimal detectable changes reported for the distances achieved by these patients will be useful to identify the effectiveness of therapies aimed at alleviating or improving impaired physical capacity. IMPLICATIONS FOR REHABILITATION The 6-min walk test could be used to measure exercise tolerance for children and adolescents with cystic fibrosis, as it is a reliable test over time. An increase in the distance covered in the 6-min walk test that exceeds the minimum detectab...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
Cystic Fibrosis (CF) is a monogenic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, resulting in defective CFTR-mediated chloride and bicarbonate transport, with dysregulation of epithelial sodium channels (ENaC). These changes alter fluid and electrolyte homeostasis and result in an exaggerated proinflammatory response driven, in part, by infection. We tested the hypothesis that NLRP3-inflammasome activation and ENaC upregulation drives exaggerated innate-immune responses in this multisystem disease. We identify an enhanced proinflammatory signature, as evidenced by incr...
Source: eLife - Category: Biomedical Science Tags: Human Biology and Medicine Immunology and Inflammation Source Type: research
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