Bronchiectasis is a respiratory disease characterized by the permanent enlargement of parts of the airways of the lung. The bronchiectasis guidelines recommend the use of antibiotics for the treatment of acute respiratory exacerbations. This study aims to evaluate the efficacy of amoxicillin-clavulanate and azithromycin for non-severe respiratory exacerbations in children with bronchiectasis.

This three-arm, multicenter, parallel, double-blind, double-dummy, placebo-controlled, randomized trial included a total of 197 children aged 1-18 years with CT-confirmed bronchiectasis with respiratory exacerbations. The patients were randomly assigned in a 1:1:1 ratio to receive amoxicillin-clavulanate plus placebo azithromycin, azithromycin, plus placebo amoxicillin-clavulanate, or both placebo for 14 days. The primary outcome of the study was the proportion of children with exacerbation resolution.

Of 197children, 152 had nasal swabs, and respiratory viruses were identified in 82 (53%) of them. By the end of day 14, exacerbations had resolved in 65% of children in the amoxicillin-clavulanate group, 61% in the azithromycin group, and 43% in the placebo group. The relative risk of resolution by day 14 was 1.50 in the amoxicillin-clavulanate group and 1.41 in the azithromycin group, when compared with placebo.

The research concluded that amoxicillin-clavulanate treatment resulted in improved resolution of respiratory exacerbations than azithromycin in children with bronchiectasis.