Azithromycin administered for acute bronchiolitis may have a protective effect on subsequent wheezing

Abstract

Objective: A significant proportion of the infants developed recurrent wheezing after an acute bronchiolitis (AB) event. Recent studies have demonstrated protection for recurrent wheeze and lower respiratory morbidity in infants treated with azithromycin during an acute respiratory wheezing. The aim of the present study was to test the hypothesis that administration of azithromycin during an AB event reduces subsequent wheezing and hospital re-admissions. Methods: This is a secondary analysis of a randomized, double-blinded, placebo-controlled trial, including unpublished data of wheezing and hospitalizations during the initial 6 months following admission for acute viral bronchiolitis. The study was performed in a tertiary University hospital. Infants (<12 months of age) hospitalized with AB were randomized to receive either azithromycin or placebo, administered orally, for 7 days. Families were contacted by telephone at 3 and 6 months after the initial acute event and answered to a standardized questionnaire in order to identify recurrent wheezing and hospital readmissions. Results: One hundred and four patients were included (Azithromycin group, n= 50; placebo group, n=54). Considering the total of patients contacted 3 months after hospitalization (n=70), the recurrence rate of wheezing in the azithromycin group was significantly lower than in the placebo group (RR = 0.48; CI = 0.24-0.98; p = 0.038). Conclusion: Azithromycin significantly reduces the risk of subsequent wheezing between 0 and 3 months after hospital admission due to acute bronchiolitis irrespective of the presence of respiratory syncytial virus.

Azithromycin attenuates wheezing after pulmonary inflammation through inhibiting histone H3K27me3 hypermethylation mediated by EZH2

“…A recent report showed that the long-term low-dose use of AZM inhibits the production of pro-inflammatory cytokines and enhances macrophage phagocytosis and anti-inflammatory cytokine expression [ 54 ]. Studies have also found that AZM may be protective against wheezing in acute bronchiolitis and that AZM treatment reduces the need for short-acting β2-agonists in preschool children with recurrent wheezing [ 55 ]. These data suggested that AZM has a positive effect on wheezing diseases after pulmonary inflammation.…”

Mechanism of action, resistance, synergism, and clinical implications of azithromycin

“…That study demonstrated that 10 mg/kg of AZM can reduce the rate of recurrent wheezing, which was significantly occurred less than 6 months after discharge. 133 By analyzing some double‐blinded placebo‐controlled studies, Che et al evaluated the clinical efficacy of AZM adjuvant therapy in 1328 children with bronchiolitis; 667 and 661 children received AZM and placebo, respectively. The results of their study revealed that AZM could significantly diminish the time to the relief of wheezing and the detection rates of Haemophilus influenza , Moraxella catarrhalis , and Streptococcus pneumoniae in the nasopharyngeal region.…”

“…In a secondary analysis of a randomized double‐blinded placebo‐controlled trial, 104 infants (50 in AZM group and 54 in placebo group) were studied. That study demonstrated that 10 mg/kg of AZM can reduce the rate of recurrent wheezing, which was significantly occurred less than 6 months after discharge 133 . By analyzing some double‐blinded placebo‐controlled studies, Che et al evaluated the clinical efficacy of AZM adjuvant therapy in 1328 children with bronchiolitis; 667 and 661 children received AZM and placebo, respectively.…”

“…That study demonstrated that 10 mg/ kg of AZM can reduce the rate of recurrent wheezing, which was significantly occurred less than 6 months after discharge. 133 By analyzing some double-blinded placebo-controlled studies, Che et al…”

Early Microbial–Immune Interactions and Innate Immune Training of the Respiratory System during Health and Disease

“…These results demonstrate that viruses and bacteria not only coexist during respiratory infections, but have bidirectional interactions. Modulation of these virus–bacteria interactions may be critically important to improve the clinical outcome of infants and asthmatic children, as demonstrated by the positive results of recent randomized, placebo-controlled trials aimed to assess the beneficial effect of azithromycin during viral respiratory illnesses in young children [ 49 , 50 , 51 , 52 ]. Notably, recent findings suggest that azithromycin likely operates through antimicrobial actions, as the airway microbiota composition in acute episodes of asthma-like symptoms modifies the effect of azithromycin treatment [ 53 , 54 ].…”