Effect of prophylactic azithromycin on chest infections in children with neurological and neuromuscular impairment

Children with neurological conditions such as cerebral palsy often experience recurrent chest infections that can lead to hospitalisation, worsening health, and even premature death. Some doctors prescribe long-term low-dose antibiotics to prevent these infections, but solid evidence about whether this is beneficial or risky is lacking. The PARROT-Junior trial is testing whether regular azithromycin — a commonly used antibiotic — reduces the frequency of chest infections in young children with neurological impairment. Children aged 6 months to 3 years are randomly assigned to receive either azithromycin or a placebo for 6 months. Their rates of chest infections, antibiotic use, hospitalisations, and any side effects are carefully tracked. Results from this trial will be combined with data from a related larger study to build a comprehensive picture of whether this preventive antibiotic approach is both safe and effective in this vulnerable group. This trial is open to infants and young children aged 6 months to 3 years who have been diagnosed with a stable, non-progressive neurological condition and have had at least two recent courses of antibiotics for a lower respiratory tract infection, or have been hospitalised with such an infection in the past year. Children with progressive neuromuscular diseases, cystic fibrosis, or known allergy to azithromycin are not eligible.