Evidence map›Paper›PMID 26363637›Full record

Trial reportEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2015

Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo.

K M Hare, K Grimwood, A B Chang, M D Chatfield, P C Valery, A J Leach, H C Smith-Vaughan, P S Morris, C A Byrnes, P J Torzillo and 1 more

Open access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 4 pooled it
5.5field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 4 syntheses or guidelines pooled it, 61 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Macrolide antibiotics for bronchiectasis.The Cochrane database of systematic reviews · 2018
    Pooled it
  4. Pooled it
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  9. Article
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  12. Review
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  14. Observational
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  17. Antibiotic resistance in chronic respiratory diseases: from susceptibility testing to the resistome.European respiratory review : an official journal of the European Respiratory Society · 2022
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 2 countries.

K M HareChild Health Division, Menzies School of Health Research, Darwin, Australia. Kim.Hare@menzies.edu.au.
K GrimwoodMenzies Health Institute Queensland, Griffith University, Gold Coast Health, Gold Coast, Australia.
A B ChangChild Health Division, Menzies School of Health Research, Darwin, Australia.
M D ChatfieldMenzies School of Health Research, Darwin, Australia.
P C ValeryMenzies School of Health Research, Darwin, Australia.
A J LeachChild Health Division, Menzies School of Health Research, Darwin, Australia.
H C Smith-VaughanChild Health Division, Menzies School of Health Research, Darwin, Australia.
P S MorrisChild Health Division, Menzies School of Health Research, Darwin, Australia.
C A ByrnesDepartment of Paediatrics, University of Auckland, Auckland, New Zealand.
P J TorzilloSydney Medical School, University of Sydney, Sydney, Australia.
A C ChengInfectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Menzies School of Health Research · AUGriffith University · AUAlfred Health · AUUniversity of Auckland · NZUniversity of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3-6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 % versus 92 %). Adherence ≥70 % (versus <70 %) in the Australian azithromycin group was associated with lower carriage of any pathogen [odds ratio (OR) 0.19, 95 % confidence interval (CI) 0.07-0.53] and fewer macrolide-resistant pathogens (OR 0.34, 95 % CI 0.14-0.81). Post-intervention (median 6 months), macrolide resistance in S. pneumoniae declined significantly in the azithromycin group, from 79 % (11/14) to 7 % (1/14) of positive swabs, but S. aureus strains remained 100 % macrolide resistant. Azithromycin treatment, the Australian remote setting, and adherence <70 % were significant independent determinants of macrolide resistance in children with bronchiectasis. Adherence to treatment may limit macrolide resistance by suppressing carriage.

Indexed as

Drug Resistance, BacterialAnti-Bacterial AgentsAustraliaAzithromycinBacteriaBacterial InfectionsBronchiectasisCarrier StateChildChild, PreschoolFemaleHumansInfantMacrolidesMaleNasopharynxAnti-Bacterial AgentsAzithromycinMacrolidesPlacebos

Identifiers

PMID26363637
OpenAlexW1900325664

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.