Comparison of bronchoscopy and bronchoalveolar lavage findings in three types of suppurative lung disease

Abstract

In this first study to directly compare bronchoscopic data among young children with PBB, bronchiectasis, and CF, microbiological patterns of airway infections and neutrophilia varied. Our findings of cytomegalovirus and EBV detection in children with PBB and bronchiectasis require confirmation and further evaluation.

Efficacy of oral amoxicillin–clavulanate or azithromycin for non-severe respiratory exacerbations in children with bronchiectasis (BEST-1): a multicentre, three-arm, double-blind, randomised placebo-controlled trial

“…Between April 17, 2012, and March 1, 2017, 604 children were screened and 252 were enrolled. 197 children were [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]). This higher rate of resolution in the amoxicillin-clavulanate group was formally statis tically significant (as per our apriori definition) 17 after accounting for use of the same placebo group in comparisons with the amoxicillin-clavulanate group and the azithromycin group, as well as for the interim analysis.…”

“…[5][6][7] The predominant pathogens detected in the lower airways of children with bronchiectasis are Haemophilus influenzae, Strepto coccus pneumoniae, and Moraxella catarrhalis, whereas (unlike in cystic fibrosis) Pseudomonas aeruginosa is uncommon. 2,8 Accordingly, the combined Australian and New Zealand guidelines for bronchiectasis in children and adults recommend amoxicillin-clavulanate as the empirical firstline oral antibiotic for nonsevere exacerbations. 5 The 2019 British Thoracic Society guidelines for bronchiectasis in adults also recommend using oral amoxicillin or amoxicillin-clavulanate for exacerbations in adults, while highlighting the absence of randomised placebo controlled trials.…”

Amoxicillin–clavulanate versus azithromycin for respiratory exacerbations in children with bronchiectasis (BEST-2): a multicentre, double-blind, non-inferiority, randomised controlled trial

“…In the past two decades, bronchiectasis has been recognised increasingly as a relatively common, but often underdiagnosed and under-researched chronic disease. 1 Because the lower airway microbial profiles in children with bronchiectasis differ from adults with this disorder and from children with cystic fibrosis, 22 having data from children with bronchiectasis is important. This trial is also the first to compare amoxicillin-clavulanate with azithromycin using a non-inferior hypothesis that was determined a priori.…”

“…Azithromycin has good activity against S pneumoniae, M catarrhalis, and atypical pathogens, although the latter may not be so important in this patient population. 22 At least for some cases, azithromycin might not be as effective as amoxicillin-clavulanate at eradicating H influenzae, 24 which is the predominant pathogen in the lower airways of children with bronchiectasis, 22 which is why we used a non-inferiority design in this trial.…”

Pediatric Pulmonology year in review 2018: Asthma, physiology/pulmonary function testing, and respiratory infections

“…Using a multivariable analysis approach, high BALF total cell counts (>400 000 cells/mL) and neutrophilia (>15% of leukocytes) were respectively significantly associated with 10 4 and 10 5 bacterial colony forming units/mL BALF. The same group compared BALF microbiologic and inflammatory markers among children with three types of suppurative lung disease: protracted bacterial bronchitis (PBB), bronchiectasis, and cystic fibrosis (CF). Surprisingly, cytomegalovirus and Epstein‐Barr virus were relatively commonly detected by PCR in children with either PBB or non‐CF bronchiectasis.…”