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Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
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Question 4: Is there a role for antibiotics in infantile wheeze?
Fernando M de Benedictis1, Ines Carloni2, Roberto Guidi2
1Salesi Children's Hospital Foundation, Ancona, Italy.
Paediatric Respiratory Reviews
|December 4, 2019
Summary
Antibiotic treatment for acute wheezing in young children yielded controversial results. Current evidence suggests azithromycin may benefit only those with severe, recurrent episodes, not general use.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Microbiology
Background:
- Acute wheezing is common in young children, leading to significant morbidity and healthcare use.
- Respiratory viruses are known triggers, but airway bacteria also play a role, alone or with viruses.
- The impact of bacteria on acute asthma exacerbations is increasingly recognized.
Purpose of the Study:
- To evaluate the effectiveness of antibiotic interventions targeting airway bacteria in preschool children with acute wheezing.
- To assess the potential of antibiotics like azithromycin in reducing wheezing severity and recurrence.
- To analyze the controversial findings from recent randomized controlled trials.
Main Methods:
- Three randomized, double-blind, placebo-controlled trials were reviewed.
- Studies focused on interventions with antibiotics (azithromycin) during acute wheezing episodes.
- Data on wheezing severity and recurrence in preschool children were analyzed.
Main Results:
- Results from the trials are controversial, indicating no universal benefit of antibiotic intervention.
- Widespread antibiotic use for acute wheezing in young children is not supported by current evidence.
- A potential benefit might exist for children experiencing severe, recurrent wheezing episodes.
Conclusions:
- Antibiotic intervention with azithromycin cannot be broadly applied to all young children with acute wheezing.
- The use of antibiotics should be reserved for specific cases, such as severe or recurrent wheezing.
- Further research is needed on risk factors, virus-bacteria interactions, and biomarkers for targeted treatment.
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