The AMIC study is a double-blind, placebo-controlled, multicenter, nationwide, randomized controlled academic pharmaceutical trial. OVERALL PRIMARY OBJECTIVES: * To study the clinical efficacy of antibiotics in children with chronic wet cough (CWC). * To study if duration of treatment with antibiotics in children with CWC has impact on efficacy or time to relapse of symptoms. OVERALL SECONDARY OBJECTIVE: -To study respiratory pathogens and the diversity/composition of airway and gut microbiome in children with CWC compared to healthy controls, and changes in pathogens/microbiome after treatment with antibiotics. OVERALL TERTIARY OBJECTIVE: -To study the role of inflammation, immunology, and genetics in children with chronic wet cough and suspicion of PBB to increase the knowledge of pathophysiological mechanisms associated with PBB. The study will include two different RCTs AMIC 1 and AMIC 2: AMIC 1: Participants will be randomly assigned to 14 days amoxicillin-clavulanate syrup or placebo. AMIC 2: Participants will be randomly assigned 1:1 to receive either 14 or 28 days with amoxicillin-clavulanate syrup.
Study populations: AMIC 1: 90 children with chronic wet cough aged 9-36 months. AMIC 2: 210 children with chronic wet cough aged 9-36 months. All children will be followed until 24 months after the start of the Randomized Controlled Trial (RCT). HEALTHY CONTROL GROUP: To study the role of respiratory pathogens, airway and gut microbiome, inflammation and immunology, 50 healthy controls will be included for comparison to AMIC 1. The healthy controls will have a second visit 6 months after inclusion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
350
Three times daily
Three times daily
Ålesund Hospital
Ålesund, Norway
RECRUITINGHaukeland University Hospital
Bergen, Norway
RECRUITINGAkershus University Hospital
Lillestrøm, Norway
RECRUITINGOslo University Hospital
Oslo, Norway
RECRUITINGStavanger University Hospital
Stavanger, Norway
RECRUITINGUniversity Hospital of North-Norway
Tromsø, Norway
RECRUITINGTrondheim University Hospital
Trondheim, Norway
RECRUITINGResponse to treatment
Response to treatment is defined as an improvement in baseline validated Verbal category descriptive (VCD) cough score ≤2 at the end of treatment or cessation of coughing for a minimum period of 3 days within the treatment period.The VCD score has a minimum and maxiumum score ranging from 0-10 points, and a higher value corresponds to more severe cough.
Time frame: Response to treatment will be assessed 14 days after end of antibiotic treatment
Relapse of symptoms
Relapse of symptoms after antibiotic treatment for chronic wet cough is defined as a new period of wet cough - after a period of at least 7 days without symptoms - lasting for more than four weeks, or an episode of wet cough of at least two weeks duration which was treated with antibiotics by the child's general practitioner or treating physician. The start of relapse is the first day of cough of such a period or episode.
Time frame: Relapse of symptoms will be assessed up to 24 months after end of antibiotic treatment
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