Azithromycin treatment in children hospitalized with asthma: a retrospective cohort study

Abstract

Objective: Azithromycin has anti-inflammatory properties in the lungs and decreases the duration of asthma-like episodes in children. We sought to evaluate length of stay (LOS) and readmission rates of children receiving azithromycin therapy during hospitalization for acute asthma exacerbations. Methods: This was a retrospective cohort study at an urban, quaternary-care children's hospital including patients under 18 years old hospitalized for asthma, without concurrent infection, from 2002 to 2011. The primary predictor was azithromycin therapy administered within 48 hours of admission. The primary outcome was LOS and the secondary outcomes were 7, 30, and 90-day hospital readmission rates for asthma. Results: Azithromycin therapy was administered to 174 (3%) of 5335 unique patients admitted for asthma, without concurrent infection, over the 10-year period. The overall median LOS was 2.3 days [Interquartile range, 1.8-3.1] and 9% (480) were readmitted for asthma within 90 days of discharge. Azithromycin therapy was associated with a 20% (11 hour) longer LOS (adjusted beta coefficient for log-transformed LOS, 0.18; 95% Confidence Interval (CI): 0.11-0.26), less than the 29% (16 hour) difference determined a priori as clinically relevant. Azithromycin therapy was not associated with 90-day readmission for asthma (adjusted odds ratio, 0.89; 95% CI: 0.46-1.72]. The limited number of 7 and 30-day readmissions in the azithromycin treated group precluded adjusted analysis. Conclusions: Azithromycin therapy was not associated with a clinically relevant difference in hospital LOS or with readmission rates for children hospitalized with asthma. Prospective trials are needed to determine the clinical effects of azithromycin therapy in children with asthma.

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

“…13,16 Recently, a retrospective observational study in approximately 20,000 adults with asthma exacerbation found that antibiotic therapy could be related to longer hospital stay, higher hospital cost, and similar risks of treatment failure. 1 Correspondingly, similar findings were observed from a retrospective observational study with approximately 5000 children hospitalized for asthma exacerbation 34 ; however, these findings were limited by the small sample size of the antibiotic therapy group (n 5 174) and the use of only 1 type of antibiotic (azithromycin). Our results extend the previous findings and confirm the lack of benefits of early treatment with antibiotics, including macrolide, cephalosporin, and penicillin, when added to systemic corticosteroids and short-acting b 2 -agonist inhalation among children hospitalized for asthma exacerbation in the absence of evidence of bacterial infection.…”

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

“…The results showed that clarithromycin therapy reduced mucosal TNF-α, IL-1β, and IL-10 concentrations in children with acute exacerbation of asthma [19]. In the third study, Johnston et al [6] reported that telithromycin treatment significantly improved the lung function, including the forced expira- tory volume in 1 s, resulting in a 50% reduction in asthma symptoms, in contrast to azithromycin, which induced no significant therapeutic benefit [20,21]. No study has yet reported that antibiotics can induce longer duration asthmatic symptoms, such as wheezing, in contrast to the present results.…”

Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma

“…Despite experimental evidence, it has not yet been shown, that treatment with azithromycin as anti-viral and immunomodulatory agent has a significant impact on symptome scores, lung function parameters or length of stay during asthma exacerbations. 7 13 21 . Especially the high use in preschool age in our cohort should be critically discussed.…”