The retention of secretions due to poor airway clearance, and the high
prevalence of recurrent, aspiration that promotes the colonization of
the lower airways with organisms from the oropharynx, predispose
children with EA-TEF to recurrent LTRIs9,12,17,145.
There was strong agreement that these factors justify the lower
threshold for initiating antibiotics with the development of symptoms
such as increased “wet” cough (even without fever) or when cultures
from BAL are positive for bacterial pathogens even in the absence of
symptoms.
Borrowing primarily from the experience in patients with Cystic
Fibrosis146–148, there was strong agreement on the
use of prophylactic azithromycin due to its antimicrobial and
anti-inflammatory properties for patients with chronic symptoms,
especially those with documented
bronchiectasis149,150. However, there was only
moderate agreement on using antibiotics in asymptomatic children who
have positive BAL cultures especially with organisms are considered to
be “normal” oral flora.
There are no systematic studies on the exact organisms that may colonize
the airways of patients with EA-TEF, but it is reasonable to assume that
they are colonized by the same organisms found in children without
EA-TEF who have chronic wet cough (such as Haemophilus influenzae,
Staphylococcus aureus and Streptococcus pneumoniae, Moraxella
Catarrhalis) 50,70,111, as well as anaerobic
organisms due to possible aspiration. Most of these organisms are
usually sensitive to amoxicillin/clavulanic acid that is recommended for
the treatment of chronic cough151.