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.