Role of atypical bacteria and azithromycin therapy for children with recurrent respiratory tract infections.
BACKGROUND
The aim of this study of 352 patients, 1-14 years of age, with acute respiratory infections and a history of recurrent respiratory tract infections (RRTIs), and 208 healthy subjects was to evaluate whether Mycoplasma pneumoniae and Chlamydia pneumoniae played a role in causing acute respiratory episodes among children with RRTIs and whether specific antibiotic treatment for these bacteria could improve the acute episodes and reduce recurrences.


METHODS
The patients were blindly randomized to receive azithromycin (10 mg/kg/d for 3 days weekly, for 3 weeks) together with symptom-specific agents or symptom-specific agents alone. Acute M. pneumoniae and/or C. pneumoniae infection was diagnosed if the child had a significant antibody response in paired sera and/or if the DNA of the bacteria was detected in nasopharyngeal aspirates.


RESULTS
Atypical bacterial infections were identified for 190 patients (54.0%) and 8 healthy control subjects (3.8%; P < 0.0001). Short term (1-month) clinical success was significantly more frequent among the patients who had received azithromycin together with symptom-specific agents than among those who had received symptom-specific agents alone, but the difference was significant only for the group of patients with atypical bacteria. In contrast, long term (6-month) clinical success was significantly more frequent among the patients who had received azithromycin in addition to symptom-specific agents, regardless of whether they experienced infections with atypical bacteria or other pathogens, although positive outcomes were significantly more frequent among those with atypical bacteria.


CONCLUSIONS
Atypical bacteria seem to play a role among children with RRTIs, and prolonged azithromycin therapy can significantly improve the acute episodes and reduce the risk of recurrences.
Esposito
Susanna
S
Institute of Pediatrics, Fondazione IRCCS "Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena," University of Milan, Milan, Italy.
Bosis
Samantha
S
Faelli
Nadia
N
Begliatti
Enrica
E
Droghetti
Roberta
R
Tremolati
Elena
E
Porta
Alessandro
A
Blasi
Francesco
F
Principi
Nicola
N
D000293:Adolescent; D000554:Ambulatory Care Facilities; D017963:Azithromycin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D023521:Chlamydophila Infections / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D012008:Recurrence; D012016:Reference Values; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D017963:Azithromycin