Hospitalized children with asthma do not benefit from routine azithromycin given in hospital
Azithromycin has been found to be of use in some asthmatic patients because of its immunomodulatory effects on the respiratory tract, in addition to its antibiotic effect. Overuse, however, could lead to resistance, so patient selection needs to be careful. The study below shows that routine use of azithromycin in hospitalized asthmatics is not indicated
Children who were hospitalized for asthma exacerbations and were prescribed azithromycin did not have shorter lengths of stay or a decreased risk for adverse events compared with children who received a placebo, according to findings of a randomized clinical trial presented at the Pediatric Academic Societies Meeting.
Lindsey C. Douglas, MD, assistant professor of paediatrics at Mount Sinai Kravis Children’s Hospital, told Infectious Diseases in Children that azithromycin is given off-label to children with asthma for its anti-inflammatory effects on the lungs. She said it was unclear whether azithromycin’s ability to reduce lung inflammation led to clinical improvements.
The researchers analysed the outcomes of 159 children aged 4 to 12 years with persistent asthma who were hospitalized for asthma exacerbation. All children received treatment between October 2013 and May 2018 at a single urban, quaternary care centre. Patients received either 10 mg/kg of oral azithromycin per day for 3 days (n = 80) or a placebo (n = 79) within 12 hours of hospital admission.
The researchers hypothesized that azithromycin would reduce a 3-day length of stay (LOS) by 16 hours.
Douglas and colleagues observed no statistically significant differences in LOS between the two groups (placebo = 1.86 days; azithromycin = 1.69 days). Rates of persistent asthma symptoms, asthma readmission rates and missed days of school or work 1 week and 1 month after admission were similar among the two groups as well.
Secondary adverse events — including gastrointestinal side effects, ICU admission and study exit — were rare among patients, and no differences in the rates of these events were observed between the azithromycin and placebo groups.
Douglas said the findings may enhance antimicrobial stewardship efforts.
“Azithromycin is currently being used off-label for asthma, and we didn’t find that it was beneficial clinically for children hospitalized with asthma,” she said. “This study will help antibiotic stewards curb the use of azithromycin for this indication.” – by Katherine Bortz