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.

Our study found;

• That azithromycin is non-inferior to amoxicillin-clavulanate for resolving exacerbations in children with bronchiectasis, however it takes longer to resolve an exacerbation when azithromycin is used.
• Both amoxicillin-clavulanate and azithromycin improves the resolution of bronchiectasis exacerbations on day 14 compared to the placebo,
• Respiratory viruses were identified in 53% of children on the first day of treatment.

The main results of these studies are now published.

Lancet Respir Med 2019 Sep;7(9):791-801.   doi.org/10.1016/S2213-2600(19)30254-1

Lancet. 2018 Oct 6;392(10154):1197-1206.    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31723-9/fulltext

Funders: Australian National Health and Medical Research Council (NHMRC)