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Antibiotics for acute asthma
V Graham1, T Lasserson, B H Rowe
151, Clancarty Road, London, UK, SW6 3AH.
Background:
Antibiotics are often prescribed to patients who are admitted to hospital with acute asthma. Their exacerbation is often precipitated by a viral upper respiratory infection (URTI), but in some instances antibiotics are prescribed in spite of questionable efficacy. A lack of strong evidence either to support or to refute the use of treatments in acute asthma leaves room for discussion and debate as to how effective antibiotics are in an acute setting. This review assesses what evidence is available.
Objectives:
To determine the efficacy of antibiotics prescribed in the treatment of acute asthma
Search Strategy:
Electronic databases (MEDLINE, EMBASE and CINAHL) were searched to identify all possible randomised control trials.
Selection Criteria:
Only RCTs or quasi RCTs were eligible for inclusion. Studies were included if patients were treated for acute asthma in the ED or its equivalent with antibiotics or placebo. Two reviewers independently assessed articles for potential relevance, final inclusion, and methodological quality.
Data Collection And Analysis:
Two reviewers completed trial quality assessment and data extraction independently.
Main Results:
From 128 potential studies, two trials were identified for inclusion in the review. Both trials reported numbers of exacerbations and not patient numbers due to re admissions over the course of the trials. The total number of patients in this review was 97, but values were recorded for 115 exacerbations.
Reviewer'S Conclusions:
The role of antibiotics in the treatment of acute asthma is difficult to assess from the current literature. Recommendations regarding antibiotic use in acute asthma will remain consensus driven until more research is conducted which includes larger numbers of patients.
Insights
The efficacy of antibiotics for acute asthma is unclear due to limited research. More studies are needed to guide treatment recommendations for acute asthma exacerbations.
Area of Science:
- Pulmonology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antibiotics are frequently prescribed for acute asthma exacerbations, often triggered by viral upper respiratory infections (URTIs).
- The efficacy of antibiotics in treating acute asthma remains debated due to a lack of robust evidence.
- This review examines the available evidence on antibiotic use in acute asthma management.
Purpose of the Study:
- To evaluate the effectiveness of antibiotic therapy in patients with acute asthma.
Main Methods:
- A systematic literature search was conducted using MEDLINE, EMBASE, and CINAHL to identify randomized controlled trials (RCTs).
- Studies included were RCTs or quasi-RCTs involving patients treated for acute asthma with antibiotics or placebo.
- Two independent reviewers assessed study relevance, inclusion, and quality, and performed data extraction.
Main Results:
- Only two RCTs, involving 97 patients and reporting 115 exacerbations, met the inclusion criteria.
- The included trials primarily reported the number of exacerbations rather than patient re-admission numbers.
- Data from these limited trials make a definitive assessment challenging.
Conclusions:
- Current literature provides insufficient evidence to definitively establish the role of antibiotics in treating acute asthma.
- Further research with larger patient cohorts is necessary to inform evidence-based recommendations for antibiotic use in acute asthma.
- Treatment guidelines for acute asthma will likely remain consensus-based until more comprehensive studies are available.