Association between early antibiotic treatment and clinical outcomes in children hospitalized for asthma exacerbation

Okubo, Yusuke; Horimukai, Kenta; Michihata, Nobuaki; Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1016/j.jaci.2020.05.030

Cited by 11 publications

(8 citation statements)

References 37 publications

(57 reference statements)

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“…We described weekly trends in the number of hospitalizations with a primary diagnosis of asthma (International Classification of Diseases 10 [ICD-10] code: J45 or J46), 6 based on the date of admissions. We also examined the hospitalizations with a primary diagnosis of COVID-19 (ICD-10 code: U07) to illustrate the COVID-19 epidemic in Japan.…”

mentioning

confidence: 99%

Trends in hospitalizations for asthma during the COVID-19 outbreak in Japan

Abe

Miyawaki

Nakamura³

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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mentioning

confidence: 99%

Trends in hospitalizations for asthma during the COVID-19 outbreak in Japan

Abe

Miyawaki

Nakamura³

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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“…In a large retrospective Japanese study in children hospitalized for asthma exacerbation, in comparison with those who did not receive antibiotics, children with early antibiotic treatment had a longer hospital stay (mean difference 0.21 days, 95% CI 0.18–0.28), higher hospitalization cost (mean difference 83.5 USD, 95% CI 62.9–104) and greater probiotic use (RR 2.01, 95% CI 1.81–2.23) [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Fainardi

Caffarelli

Deolmi

et al. 2022

JCM

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Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

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“…A previous study reported that nearly 60% of adult patients hospitalized for asthma received antibiotics in the absence of documentation of an indication for antibiotic treatment [14]. Similarly to these adult patients, it has been reported that 41% of children hospitalized for asthma exacerbation in Japan received early antibiotic treatment [15]. Studies in the United Kingdom and Netherlands showed that the prevalence rate ratio of antibiotic treatment in children with asthma versus antibiotics in nonasthmatic children was 1.60-1.65 [3].…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the United Kingdom and Netherlands showed that the prevalence rate ratio of antibiotic treatment in children with asthma versus antibiotics in nonasthmatic children was 1.60-1.65 [3]. These high rates of antibiotic prescription raise concerns about antimicrobial resistance, leading to increased medical costs, prolonged hospital stays, and increased mortality [15]. In fact, several studies have suggested that antibiotic treatment in adult or pediatric patients hospitalized for asthma exacerbation was associated with a longer hospital stay and greater hospitalization costs without any marked improvement in treatment failure or readmission rates [15,16].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Treatments Prolong the Wheezing Period in Acute Exacerbation of Childhood Bronchial Asthma

Kama

Yamada

Kitahara

et al. 2022

Int Arch Allergy Immunol

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Introduction: Although current guidelines recommend against routine antibiotic prescription for acute exacerbation of bronchial asthma, children with acute exacerbation of asthma receive antibiotic treatment more frequently. In addition, those antibiotics are often prescribed only for exacerbation of asthma without concurrent bacterial infection. Objective: To clarify the association between antibiotic treatment and bacterial colonization in acute exacerbation of asthma, we investigated whether or not antibiotics affect the clinical condition, laboratory findings, and pharyngeal bacterial colonization in those patients. Methods: Potential bacterial pathogens were investigated in pharyngeal samples of 111 children with acute exacerbation of asthma (mean/median age: 2.8/2.6 years old, respectively). We collected clinical data, such as the duration of wheezing and antibiotic use, and measured the peripheral white blood cell counts, C-reactive protein, and serum levels of total and allergen-specific IgE. Results: Antibiotics were used in 50.5% patients with acute asthma exacerbation and included cephalosporin, penicillin, macrolide, and others. Episodes of wheezing were significantly longer in patients with antibiotic treatment than in those without it (6.7 ± 3.6 days vs. 6.0 ± 3.1, p = 0.044). Similarly, episodes of wheezing were significantly longer in moderate exacerbation patients with antibiotics than in those without them. Furthermore, in patients with Streptococcus pneumoniae, antibiotic treatment was associated with an extended duration of wheezing in cases of acute moderate exacerbation (7.0 ± 2.4 days vs. 4.8 ± 4.1, p = 0.043). Conclusions: These results suggest that antibiotic treatment in acute exacerbation of asthma might lead to longer asthmatic symptoms, specifically in patients with pharyngeal S. pneumoniae colonization.

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Association between early antibiotic treatment and clinical outcomes in children hospitalized for asthma exacerbation

Cited by 11 publications

References 37 publications

Trends in hospitalizations for asthma during the COVID-19 outbreak in Japan

Trends in hospitalizations for asthma during the COVID-19 outbreak in Japan

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Antibiotic Treatments Prolong the Wheezing Period in Acute Exacerbation of Childhood Bronchial Asthma

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