{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:39:37Z","timestamp":1787017177942,"version":"build-2736575974"},"reference-count":46,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2023,3,24]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>The management of many chronic lung diseases involves multiple antibiotic prescriptions either to treat acute exacerbations or as prophylactic therapy to reduce the frequency of exacerbations and improve patients\u2019 quality of life.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate the effects of antibiotics on the homeostasis of bacterial communities in the airways, and how this may contribute to antimicrobial resistance (AMR) among respiratory pathogens and microbiota.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Within an observational cohort study, sputum was collected from 84 patients with chronic obstructive pulmonary disease and\/or bronchiectasis at stable state: 47 were receiving antibiotic prophylaxis therapy. V3-V4 16S-rRNA sequencing on Illumina MiSeq, quantitative PCR for typical respiratory pathogens, bacteriology cultures and antimicrobial susceptibility testing of sputum isolates, resistome analysis on a subset of 17 sputum samples using MinION metagenomics sequencing were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Finding<\/jats:title>\n                    <jats:p>\n                      The phylogenetic \u03b1-diversity and the total bacterial density in sputum were significantly lower in patients receiving prophylactic antibiotics (p=0.014\u2009and 0.029, respectively). Antibiotic prophylaxis was associated with significantly lower relative abundance of respiratory pathogens such as\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      ,\n                      <jats:italic>Moraxella catarrhalis<\/jats:italic>\n                      and members of family Enterobacteriaceae in the airway microbiome, but not\n                      <jats:italic>Haemophilus influenzae<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      . No major definite directional shifts in the microbiota composition were identified with prophylactic antibiotic use at the cohort level. Surveillance of AMR and resistome analysis revealed a high frequency of resistance to macrolide and tetracycline in the cohort. AMR expressed by pathogenic bacterial isolates was associated with antibiotics prescribed as \u2018rescue packs\u2019 for prompt initiation of self-treatment of exacerbations (Spearman\u2019s rho=0.408, p=0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Antibiotic prophylactic therapy suppresses recognised pathogenic bacteria in the sputum of patients with chronic lung disease. The use of antibiotic rescue packs may be driving AMR in this cohort rather than prophylactic antibiotics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2022-001335","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T11:03:49Z","timestamp":1682075029000},"page":"e001335","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of prophylactic and \u2018rescue pack\u2019 antibiotics on the airway microbiome in chronic lung disease"],"prefix":"10.1136","volume":"10","author":[{"given":"Sylvia A D","family":"Rofael","sequence":"first","affiliation":[{"name":"UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK"},{"name":"Faculty of Pharmacy, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Brown","sequence":"additional","affiliation":[{"name":"UCL Respiratory, Divison of Medicine, University College London, London, UK"},{"name":"Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc C I","family":"Lipman","sequence":"additional","affiliation":[{"name":"UCL Respiratory, Divison of Medicine, University College London, London, UK"},{"name":"Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Lowe","sequence":"additional","affiliation":[{"name":"Institute for Immunity and Transplantation, Divison of Infection and Immunity, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Spratt","sequence":"additional","affiliation":[{"name":"Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumonta","family":"Quaderi","sequence":"additional","affiliation":[{"name":"UCL Respiratory, Divison of Medicine, University College London, London, UK"},{"name":"Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Hurst","sequence":"additional","affiliation":[{"name":"UCL Respiratory, Divison of Medicine, University College London, London, UK"},{"name":"Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D","family":"McHugh","sequence":"additional","affiliation":[{"name":"UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"2025083110324058000_10.1.e001335.1","unstructured":"WHO . 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