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    PARIS -- Azithromycin (Zithromax) for acute exacerbations in children with non-cystic fibrosis bronchiectasis was noninferior to amoxicillin-clavulanate (Augmentin) in resolving symptoms but required longer treatment duration, which carries risk of macrolide resistance, the BEST-2 trial found. Among 179 randomized patients, 84% in each group had symptom resolution after 3 weeks of antibiotic treatment (-0.3% for noninferiority, 95% CI -11.8 to 11.1), Keith Grimwood, MD, of Griffith University in Australia, reported here. "Amoxicillin-clavulanate, we believe, should remain the empirical oral antibiotic of choice for treating non-severe exacerbations of bronchiectasis," said Grimwood. Though azithromycin is seen as attractive due to its once-daily dosing, adherence was numerically higher in the twice-daily amoxicillin-clavulanate group (96% versus 86% with azithromycin, =0.14). "While after 21 days, azithromycin is non-inferior within a 20% margin to amoxicillin-clavulanate, the exacerbation takes significantly longer to resolve and antibiotic resistance remains a concern," he said. "We believe until additional data are gathered, azithromycin is best reserved for when genuine penicillin hypersensitivity exists or if there are concerns over adherence." Results of the trial, which was conducted at four hospitals in Australia and New Zealand, were presented at the European Respiratory Society meeting and simultaneously published in the Grimwood pointed out that exacerbations in pediatric patients are a common feature in this chronic, under-researched and underdiagnosed disease, which when severe can negatively impact lung function in adulthood. S., a recent study from 2013 using the Market Scan Database reported that non-cystic fibrosis bronchiectasis among adults may be more common than previously thought, with a prevalence of 139 cases per 100,000 adults, which was higher in women compared with men (180 versus 95 per 100,000). "The duration of treatment, 21 days, was chosen on the basis of the investigators' prior data of symptom resolution," wrote Heather Zar, MD, Ph D, of Red Cross Children's Hospital in Cape Town, and Mark Nicol, MBBCh, of the University of Cape Town, South Africa, in an accompanying comment. That study estimated that 70,000 new cases were diagnosed in the U. "However, European guidelines for adults recommend 2 weeks of treatment, and this is common in clinical practice." They questioned whether 3 weeks of antibiotic treatment is necessary given that patients on amoxicillin-clavulanate had their symptoms resolve at a median of 10 days (interquartile range 6-15). "Further research on the optimum duration of antibiotic therapy is needed to minimize prolonged unnecessary use, which is a key driver of antimicrobial resistance," Zar and Nicol added. Azithromycin Dosage Guide with Precautions - fluconazole 100 mg tab Azithromycin for bacterial infections Medicines for Children Zithromax, Zmax azithromycin dosing, indications, interactions.
     
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