Antibiotic reduces inflammation in young CF patients

Friday, 10 June, 2022

Antibiotic reduces inflammation in young CF patients

An Australian-led clinical trial has found that a commonly prescribed broad-spectrum antibiotic, when used as a preventive therapy, helped to reduce the inflammation associated with progressive lung disease in young children with cystic fibrosis (CF) and resulted in fewer days in hospital. The results of the study have been published in The Lancet Respiratory Medicine.

Children living with CF have a build-up of thick mucus in their lungs, making them prone to getting severe lung infections. These infections and their symptoms can result in children being admitted to hospital for lengthy periods of time, and continuous treatment with antibiotics.

The decade-long, multisite COMBAT CF trial followed 130 children from 10 CF clinics across Australia and New Zealand, from the time they were diagnosed with CF at birth until they turned three years old, to see if using the antibiotic azithromycin reduced lung inflammation and therefore changed the trajectory of the disease. The children were either given the antibiotic treatment or a placebo.

The 60-plus researchers in the COMBAT CF team found long-term use of azithromycin was safe, improved respiratory symptoms, reduced hospital stays for respiratory needs and reduced the number of courses of IV antibiotics to treat the infection. In addition, the children who were given azithromycin did not get sick as often and therefore were not admitted to hospital as much as those children in the control group. They received less oral, inhaled and intravenous antibiotics each year than children who received the placebo.

“Using azithromycin as a preventative treatment meant these kids didn’t get as sick as they otherwise would have in the first few years of their life, meaning they weren’t going into hospital as frequently and therefore didn’t need to have stronger medications to treat infection flare-ups,” said study co-leader Professor Stephen Stick, Director the Wal-yan Respiratory Research Centre — a partnership between the Telethon Kids Institute, Perth Children’s Hospital Foundation and Perth Children’s Hospital.

“Those that did present to hospital had fewer days of strong IV antibiotics, so they were able to get back to being kids faster.”

Stick said these findings are promising because they could help change the trajectory of disease in a group of children who are not yet able to access important medications such as modulator therapies. Modulator medication changes the way the CF gene works at a cellular level, making the body more efficient at clearing mucus so it does not build up; however, the majority of young children in the world do not have access to these transformative therapies.

“Most modulators are approved for school-aged kids but not for those under four years old,” Stick said. “So now we have a medication that is safe to use in early life that could slow the progression of the disease, until they are old enough for modulator therapies.

“We found this treatment reduced inflammation in the lungs of young children, which is incredibly significant because there are no other anti-inflammatory medications that are currently available to treat the lung inflammation that we see in these kids.

“Based on our study, treatment with azithromycin could significantly reduce the hospital cost for treating a young child with CF, which is about $12,000 a year.”

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