Non-cystic fibrosis bronchiectasis: Etiologic approach andeffects of long-term azithromycin in children
Non-cystic fibrosis bronchiectasis: Etiologic approach andeffects of long-term azithromycin in children
Aim: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic pulmonary problem that includes a group of heterogeneous diseases.Macrolide antibiotics are increasingly prescribed for patients with NCFB, but there are very few studies on their use in children. Thisstudy aimed to search the clinical features of children with NCFB and the effect of long-term use of azithromycin on the frequencyof aggravation, microbiological reproduction, and pulmonary function tests. Materials and Methods: A total of 79 cases diagnosed with NCFB were recorded. Clinical, laboratory, and radiological evaluationswere also recorded. Exacerbation frequency, sputum cultures, and pulmonary function tests of 27 children who received azithromycinbefore and during prophylaxis were also analyzed. Results: The median age of children was 7.6 years old (1 to 16 years), when the children were diagnosed with NCFB. Bronchiectasisetiology was detected in 62 patients. Primary ciliary dyskinesia (PCD) was the most common cause of bronchiectasis, which 24 (30%)children were diagnosed with PCD. Azithromycin treatment was given to 27 bronchiectasis patients for six months. A statisticallysignificant decrease was detected in pulmonary aggravation frequency and sputum microbiology during azithromycin treatment (p< 0.01). No significant difference was detected in the pulmonary function tests with azithromycin treatment (p > 0.05) Conclusion: The use of azithromycin in children with NCFB improves aggravation frequency but has no significant effect on thepulmonary function test.
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- 1. Smith MP. Non-cystic fibrosis bronchiectasis. J.R Coll Physicians Edinb 2011;41:132-9.
- 2. Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162:1277-84.
- 3. Emiralioglu N, Ozturk Z, Yalcin E, et al. Long term azithromycin therapy in patients with cystic fibrosis. Turk J Pediatr 2016;58:34-40.
- 4. Haworth CS, Bilton D, Elborn JS. Long- term macrolide maintenance therapy in non–cf bronchiectasis: Evidence and questions. Respir Med 2014;108:1397- 408.
- 5. Anwar GA, Bourke SC, Afolabi G, et al. Effects of long term low dose azithromycin in patients with non-cf bronchiectasis. Respir Med 2008;102:1494-6.
- 6. Behan L, Dimitrov BD, Kuehni CE, et al. PICADAR: a diagnostic predictive tool for primary ciliary dyskinesia. Eur Respir J 2016;47:1103-12.
- 7. Karadag B, Karakoc F, Ersu R, et al. Non-cystic fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration 2005;72:233-8.
- 8. Amalakuhan B, Maselli DJ, Martinez-Garcia MA. Update in Bronchiectasis 2014. Am J Respir Crit Care Med 2015;192:1155-61.
- 9. Li AM, Sonnapa S, Lex C, et al. Non- CF Bronchiectasis; does knowing etiology lead to changes in management? Eur Respir J 2005;26:8-14.
- 10. Satirer O, Yesil AM, Emiralioglu N, et al. A Review of the etiology and clinical presentation of non-cystic fibrosis bronchiectasis: a tertiary care experience. Respir Med 2018;37:35-9.
- 11. Brower KS, Del Vecchio MT, Aronoff SC. The etiologies on non Cf bronchiectasis in childhood: a systematic review of 989 subjects. BMC Pediatr 2014;10:14-4.
- 12. Bahceci S, Karaman S, Nacaroglu HT, et al. Changing epidemiology of non-cystic fibrosis bronchiectasis. Turk J Pediatr 2016;58:19-26.
- 13. Fan LC, Lu HW, Wei P, et al. Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials. BMC Infect Dis 2015;15:160.
- 14. Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non- cystic fibrosis bronchiectasis: a randomised, double-blind, placebocontrolled trial. Lancet 2012;380:660-7.
- 15. Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial. JAMA 2013;309:1251-9.
- 16. Yalcin E, Kiper N, Ozcelik U, et al. Effects of claritromycin on inflammatory parameters and clinical conditions in children with bronchiectasis. J Clin Pharm Ther 2006; 31:49-55.