Four Weeks of Antibiotics better than 2 weeks course in Kids with Chronic Wet Cough
Protracted bacterial bronchitis (PBB) is a leading cause of chronic wet cough in children. In a recent study, researchers have found that four weeks of amoxicillin-clavulanate is better than 2 weeks regimen in treating chronic wet cough in children. The study findings were published in THE LANCET Respiratory Medicine on May 25, 2021.
The current standard treatment in European and American guidelines is 2 weeks of antibiotics, but the optimal duration of therapy is unknown. Therefore, Dr Tom J C Ruffles and his team conducted a first randomized controlled trial to assess the duration of antibiotic treatment in children with chronic wet cough and suspected PBB. The researchers hypothesized that 4 weeks of amoxicillin-clavulanate is superior to 2 weeks for improving clinical outcomes.
It was a multicenter, parallel, double-blind, placebo-controlled, randomized controlled trial. The researchers included a total of 106 children with chronic (>4 weeks duration) wet cough and suspected PBB. They were randomly assigned to receive 4 weeks of amoxicillin-clavulanate (25–35 mg/kg twice daily oral suspension; 4-week group n=52) or 2 weeks of amoxicillin-clavulanate followed by 2 weeks of placebo (2-week group n=54). The major outcome assessed was a clinical cure (cough resolution) by day 28. The researchers also assessed the recurrence of PBB at 6 months, time to next exacerbation, change in Parent-proxy Cough-Specific Quality-of-Life (PC-QoL) score from baseline to day 28 and from day 28 to 7 months, adverse events, nasal swab bacteriology, and antimicrobial resistance.
Key findings of the study were:
- By day 28, the researchers found that the primary endpoint of clinical cure in the 4-week group (32 [62%] of 52 patients) was not significantly different to the 2-week group (38 [70%] of 54 patients; adjusted relative risk 0·87.).
- They noted that the time to next wet cough exacerbation was significantly longer in the 4-week group than the 2-week group (median 150 days vs 36 days; adjusted hazard ratio 0·47).
- They also noted that the rate of recurrence of PBB at six months was 53% in the 4-week group and 74% in the 2-week group. However, they found no significant difference between the groups (adjusted odds ratio 0·39).
- They observed a significant improvement in the PC-QoL from baseline to day 28 in both groups, but they found no significant difference between them (mean difference in change −0·2).
- The median PC-QOL and the data on respiratory pathogens and antimicrobial resistance were similar between groups.
- They reported 13 adverse events (25%) in the 2-week group and ten (19%) in the 4-week group.
The authors concluded, "A 4-week course of amoxicillin-clavulanate for treating children with chronic wet cough and suspected PBB confers little advantage compared with a 2-week course in achieving clinical cure by 28 days. However, as a 4-week duration led to a longer cough-free period, identifying children who would benefit from a longer antibiotic course is a priority."
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