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Prophylactic antibiotics in chronic pediatric lung disease: balancing benefit, resistance, and future care models

Isaac Martin1,2, Valerie Waters2,3

  • 1Division of Paediatric Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.

Expert Review of Respiratory Medicine
|February 23, 2026
PubMed

Insights

Prophylactic antibiotics may help children with chronic lung diseases like cystic fibrosis by reducing infections and inflammation. However, their use requires careful consideration of risks, benefits, and antimicrobial stewardship.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Pharmacology

Background:

  • Children with chronic lung diseases such as cystic fibrosis (CF), non-CF bronchiectasis (NCFB), chronic suppurative lung disease (CSLD), and primary ciliary dyskinesia (PCD) suffer from recurrent infections and persistent airway inflammation.
  • This chronic infection-inflammation cycle leads to progressive lung damage.

Purpose of the Study:

  • To review current evidence on prophylactic antibiotic use in pediatric chronic lung diseases.
  • To evaluate the efficacy and safety of macrolide and non-macrolide prophylactic strategies.
  • To provide a framework for the selective and judicious use of prophylactic antibiotics.

Main Methods:

  • A targeted literature search was performed using PubMed.
  • Included were clinical trials, observational studies, and guideline recommendations.
  • The search focused on prophylactic antibiotic strategies in children under 18 years, disease-specific outcomes, antimicrobial resistance, and stewardship.

Main Results:

  • Evidence supporting antibiotic prophylaxis varies significantly based on the specific disease and clinical situation.
  • Antimicrobial resistance and stewardship are critical considerations in prophylactic antibiotic use.
  • Individualized risk-benefit assessments are essential for determining appropriate use.

Conclusions:

  • A framework for selective, time-limited prophylactic antibiotic use is proposed.
  • This framework emphasizes individualized assessment, regular efficacy reassessment, and integration with antimicrobial stewardship principles.
  • Optimizing prophylactic antibiotic strategies is crucial for managing chronic pediatric lung diseases.
Abstract

Keywords:
Antibiotictibiotic prophylaxisantimicrobial stewardshipchronic lung diseasechronic suppurative lung diseasemacrolide antibiotics

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