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Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of
Vikas Goyal1, Stephanie T Yerkovich2, Keith Grimwood3
1Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Department of Paediatrics, Gold Coast Health, Griffith University, Gold Coast, QLD, Australia.
Insights
Indigenous children, those with milder bronchiectasis, and new abnormal lung sounds are more likely to respond to 14-day oral antibiotics for exacerbations. These findings aid in predicting treatment success for pediatric bronchiectasis.
Area of Science:
- Pediatric Pulmonology
- Clinical Trials
- Pharmacodynamics
Background:
- Antibiotic treatment for respiratory exacerbations in pediatric bronchiectasis shows variable patient responses.
- Identifying factors influencing treatment outcomes is crucial for optimizing care in children with bronchiectasis.
Purpose of the Study:
- To identify phenotypic features associated with symptom resolution in children with bronchiectasis after a 14-day oral antibiotic course for nonsevere exacerbations.
Main Methods:
- Data from two multicenter randomized controlled trials were analyzed.
- 217 children with bronchiectasis receiving at least 14 days of oral antibiotics for nonsevere exacerbations were included.
- Univariable and multivariable logistic regression identified factors associated with symptom resolution within 14 days.
Main Results:
- Symptom resolution occurred in 130 of 217 children within 14 days.
- Indigenous ethnicity (AOR, 3.59) and new abnormal auscultatory findings (AOR, 3.85) were associated with higher likelihood of response.
- Multiple bronchiectatic lobes (AOR, 0.66) and higher cough scores (AOR, 0.55) were associated with lower likelihood of response.
Conclusions:
- Phenotypic features such as Indigenous ethnicity, milder bronchiectasis, mild exacerbations, and new abnormal auscultatory signs predict better response to oral antibiotics.
- These patient and exacerbation phenotypes can aid clinical management and biomarker development for predicting antibiotic treatment success in pediatric bronchiectasis.
Background:
Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations.
Research Question:
Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified?
Study Design And Methods:
Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14 days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14 days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis.
Results:
Of the 217 study participants (52% male patients), 41% were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95% CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95% CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95% CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95% CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14 days.
Interpretation:
Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14 days of oral antibiotics.
Trial Registry:
Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.
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