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Bronchiectasis – azithromycin prophylaxis — RACP Paediatrics MCQ

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ModerateRespiratoryBronchiectasis – azithromycin prophylaxisRACP Paediatrics

A child with bronchiectasis has had 4 pulmonary exacerbations requiring IV antibiotics in the past 12 months. Sputum consistently grows Haemophilus influenzae. What additional maintenance therapy should be considered to reduce exacerbation frequency?

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Correct answer: E — Long-term azithromycin

Long-term low-dose azithromycin (3 times weekly) reduces exacerbation frequency in children with bronchiectasis who have frequent exacerbations (≥3/year). This is supported by the BEST and EMBRACE trials. ECG should be checked before starting (QTc prolongation risk). Sputum for mycobacterial culture should be obtained to exclude NTM before commencing.

Reference: RCH Melbourne – 2023 – Bronchiectasis CPG; Australian Therapeutic Guidelines – 2024