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  • Azithromycin use...

Azithromycin use during RSV not useful in preventing recurrent wheezing, may cause harm: NEJM

Written By : Hina Zahid |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-03-02T09:15:57+05:30  |  Updated On 2 March 2022 12:49 PM IST
Azithromycin use during RSV not useful in preventing recurrent wheezing, may cause harm: NEJM
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The antibiotic azithromycin has anti-inflammatory properties that can be beneficial in some chronic lung diseases, such as cystic fibrosis. With that in mind, researchers investigated its potential to prevent future recurrent wheezing among infants hospitalized with respiratory syncytial virus (RSV). With such babies at increased risk of developing asthma later in childhood, the scientists hoped to find a therapy to reduce this risk.

Findings from a recent study evaluating the impact of the antibiotic azithromycin during severe respiratory syncytial virus (RSV) bronchiolitis overwhelmingly support current national bronchiolitis guidelines, which recommend against antibiotics during acute bronchiolitis due to lack of effect on the acute illness.

There is also substantial evidence that severe RSV bronchiolitis in early life increases the likelihood of repeated wheezing episodes in early childhood, often leading to asthma.

"The major message is that antibiotics don't have a role, either in the management of acute RSV bronchiolitis or to reduce subsequent wheezing," said co-corresponding author Leonard Bacharier, MD, professor of Pediatrics at Monroe Carell Jr. Children's Hospital at Vanderbilt. "As a matter of fact, we found that antibiotics in general in our study of severe RSV bronchiolitis increased the risk of subsequent recurrent wheezing over the following two to four years."

"We need to discourage the use of this therapy, as it is potentially harmful," he said.

"Azithromycin to Prevent Recurrent Wheeze Following Severe RSV Bronchiolitis," published in NEJM Evidence, a new digital journal from the New England Journal of Medicine, looks at children hospitalized with RSV bronchiolitis during a single-center, double-blind, placebo-controlled trial.

The most recent study follows an earlier pilot trial of 40 infants hospitalized with RSV bronchiolitis where treatment with azithromycin showed a reduction in the likelihood of recurrent wheeze over the following year.

In the current study, 200 otherwise healthy 1- to 18-month-old children who were hospitalized for RSV bronchiolitis were prospectively randomized to receive either oral azithromycin or a placebo for 14 days. A total of 188 completed the study — 96 in the azithromycin group and 92 in the placebo group. The group was broadly representative of the population of children who experience severe RSV bronchiolitis.

Bacharier said it is not infrequent that antibiotics are used in the treatment of RSV because of co-occurring complications that lead medical teams to prescribe them, thinking there is a bacterial component to the illness, including fever, ear infection and pneumonia.

"This condition can be managed by supportive care — oxygen, fluids, observation, time and love," he stressed. "If a clinician is going to use an antibiotic in the setting of RSV bronchiolitis, there needs to be a very strong rationale for doing so. There is substantial evidence to suggest that children who receive antibiotics early in life are at an increased risk of developing asthma, and this study is consistent with that evidence."


azithromycinwheezingnejm evidence
Source : NEJM Evidence
Hina Zahid
Hina Zahid

    Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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