According to recent research in JAMA, azithromycin administered at the first sign of a cold in children with a history of respiratory tract illnesses reduced the likelihood of developing severe lower respiratory tract illnesses.
“Among young children with histories of recurrent severe lower respiratory tract illnesses, the use of azithromycin early during an apparent respiratory tract illness compared with placebo reduced the likelihood of severe lower respiratory tract illness,” Leonard B. Bacharier, MD, of the department of pediatrics at Washington University School of Medicine, and colleagues wrote.
The researchers conducted a double blind, randomized clinical trial on the effectiveness of azithromycin vs. placebo at reducing the development of severe respiratory tract illness. Six hundred seven children aged 12 to 71 months with histories of severe respiratory tract illness were classified into two groups: a control group assigned placebo (n = 300) and an intervention group assigned 12 mg/kg azithromycin daily for 5 days (n = 307).
Thirty-five of the 473 treated respiratory tract illnesses in the intervention group developed into severe illness, while 57 cases resulted in severe illness among 464 illnesses in the control group. Azithromycin significantly reduced the risk for developing severe lower respiratory tract illness (HR = 0.64; 95% CI, 0.41-0.98) compared with placebo.
The researchers also briefly noted the complications related to pre-emptive administration of antibiotics in order to reduce asthma-related infections.
“Although not recommended by national asthma guidelines, antibiotics are widely used in clinical practice during respiratory tract illnesses and asthma episodes,” Bacharier and colleagues wrote. “More information is needed on the development of antibiotic-resistant pathogens with this strategy.”
In a related editorial, Robyn T. Cohen, MD, MPH, and Stephen I. Pelton, MD, of Boston Medical Center at the Boston University School of Medicine, wrote that while Bacharier and colleagues’ findings are encouraging, questions related to antibiotic resistance must be answered before broadly implementing azithromycin in this manner.
“The implications of the study must also be interpreted in light of the reality that more widespread azithromycin use for a condition as common as early, intermittent childhood wheezing would increase the prevalence of macrolide resistance,” they wrote. “Until a higher risk population can be prospectively identified (rather than all children with intermittent wheezing associated with viral respiratory tract illness) for progression to severe lower respiratory tract illness, the consequences of widespread use of azithromycin, both known and hypothesized, outweigh the benefit for most children.” – by David Costill
Disclosure: Bacharier reports personal fees from Aerocrine, AstraZeneca, Boehringer Ingelheim, Cephalon, DBV Technologies, Genentech/Novartis, GlaxoSmithKline, Merck, Schering, Teva, Sanofi and WebMD. Pelton reports personal fees from Pfizer, Policy Analysis and Sanofi, and grant funding from Cempra, Merck and Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.