[Antibiotic prophylaxis in pediatric pulmonology (excluding cystic fibrosis): which indications for rotating (or alternating) antibiotics and prolonged antibiotic therapy?].

Some children with chronic lung disease associated with mucociliary clearance impairment and chronic bronchial congestion develop, during their evolution, bronchial bacterial colonization and recurrent infections. Therefore, antibioprophylaxis (ABP) is proposed by pediatric pulmonology specialists. Although some children seem improved by this strategy, it is worthy to note that no pediatric study supports its effectiveness, and no guidelines from society currently recommend its prescription. Demonstrated clinical benefits of ABP involve rare and highly targeted diseases. These children require a specialized assessment before any decision of ABP. Cystic fibrosis is definitely a situation where the interest of ABP is well established. By extension of the data obtained in adults, children with bronchiectasis (DDB) could potentially benefit from prolonged antibiotic therapy. In recurrent bacterial infections of the airways without DDB, ABP should be limited and restricted to most severe cases. In the absence of data on the benefit of alternate antibiotic treatment, we propose to focus on a single-molecule antibiotic prescribed for long periods. It may be amoxicillin, macrolides or cotrimoxazole. Furthermore, there is currently no data justifying the prescription of long-term macrolides in childhood asthma.