Once thought rare, bronchiectasis is now recognised as a significant disorder. It affects one in 68 Indigenous Australians, as well as non-Indigenous children and adults living in urban and remote Australia. It is increasingly diagnosed in children and adults with ‘difficult asthma’ and chronic cough. Effective management of bronchiectasis, particularly prevention of severe exacerbations, is associated with improved long term lung function. Evidence from well conducted intervention studies is scarce. There are no trials for the treatment of exacerbations in children with non-cystic fibrosis (CF) bronchiectasis. While some clinicians assume that antibiotics are necessary for all exacerbations, others do not. More evidence is needed to resolve the controversy, highlighting the importance of the Bronchiectasis Exacerbation Study Trial (BEST).
The aim of this project is to provide more evidence as to whether antibiotics are necessary for all exacerbations (worsening of symptoms) caused by non-cystic fibrosis (CF) bronchiectasis.
Objectives: To run a large national, multi-centre, double blind, 2 part, randomised controlled trial for children with non-cystic fibrosis bronchiectasis to determine:
1. If Azithromycin or Amoxycillin-Clavulanic Acid compared to placebo, improve the resolution of respiratory exacerbations on day 14.
2. If daily Azithromycin is non-inferior to Amoxycillin-Clavulanic Acid in achieving resolution of respiratory exacerbations on day 21.
3. To determine the role of viruses and other respiratory pathogens in children with non-CF bronchiectasis in relation to exacerbations.
The study will add to the body of evidence regarding the use of antibiotics to prevent exacerbations of non-CF bronchiectasis.
Funders: Australian National Health and Medical Research Council (NHMRC)
Collaborators:
Professor Anne Chang, Menzies School of Health Research
Professor Peter Morris, Menzies School of Health Research
Colin Robertson , Royal Children’s Hospital, Melbourne
Keith Grimwood, Queensland Children’s Medical Research Institute
Peter Van Asperen, The Children’s Hospital at Westmead
Andrew Wilson, Princess Margaret Hospital, Perth
Kerry‐Ann O’Grady, Queensland Children’s Medical Research Institute
Theo Sloots, Queensland Paediatric Infectious Disease Laboratory
Paul Torzillo, University of Sydney.