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Published on: May 10, 2024
Azithromycin administered for acute bronchiolitis may have a protective effect on subsequent wheezing
Fernanda Luisi1, Clarissa Aires Roza2, Victória d'Azevedo Silveira1
1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil.
Insights
Azithromycin treatment in infants hospitalized with acute bronchiolitis (AB) significantly reduced subsequent wheezing episodes within three months. This finding suggests azithromycin may be a valuable intervention for preventing recurrent wheezing in infants post-AB.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Recurrent wheezing is a common sequela of acute bronchiolitis (AB) in infants.
- Emerging evidence suggests azithromycin may mitigate post-AB respiratory morbidity.
- The protective effect of azithromycin on subsequent wheezing and hospitalizations requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of azithromycin in reducing recurrent wheezing after acute bronchiolitis.
- To determine if azithromycin administration during AB decreases subsequent hospital re-admissions.
Main Methods:
- Secondary analysis of a randomized, double-blind, placebo-controlled trial.
- Inclusion of unpublished data on wheezing and hospitalizations up to 6 months post-AB.
- Infants (<12 months) hospitalized with AB received oral azithromycin or placebo for 7 days.
Main Results:
- 104 infants were included (50 azithromycin, 54 placebo).
- At 3 months, the wheezing recurrence rate was significantly lower in the azithromycin group (RR = 0.48; p = 0.038).
- Data on hospital readmissions were collected via standardized questionnaires.
Conclusions:
- Azithromycin significantly reduces the risk of subsequent wheezing in the 0-3 month period post-hospitalization for acute bronchiolitis.
- The benefit of azithromycin was observed irrespective of respiratory syncytial virus (RSV) status.
- Azithromycin shows promise as a preventative therapy for post-bronchiolitis wheezing.
Objective:
A significant proportion of the infants developed recurrent wheezing after an acute bronchiolitis (AB) event. Recent studies have demonstrated protection for recurrent wheeze and lower respiratory morbidity in infants treated with azithromycin during an acute respiratory wheezing. The aim of the present study was to test the hypothesis that administration of azithromycin during an AB event reduces subsequent wheezing and hospital re-admissions.
Methods:
This is a secondary analysis of a randomized, double-blinded, placebo-controlled trial, including unpublished data of wheezing and hospitalizations during the initial 6 months following admission for acute viral bronchiolitis. The study was performed in a tertiary University hospital. Infants (<12 months of age) hospitalized with AB were randomized to receive either azithromycin or placebo, administered orally, for 7 days. Families were contacted by telephone at 3 and 6 months after the initial acute event and answered to a standardized questionnaire in order to identify recurrent wheezing and hospital readmissions.
Results:
One hundred and four patients were included (Azithromycin group, n= 50; placebo group, n=54). Considering the total of patients contacted 3 months after hospitalization (n=70), the recurrence rate of wheezing in the azithromycin group was significantly lower than in the placebo group (RR = 0.48; CI = 0.24-0.98; p = 0.038).
Conclusion:
Azithromycin significantly reduces the risk of subsequent wheezing between 0 and 3 months after hospital admission due to acute bronchiolitis irrespective of the presence of respiratory syncytial virus.
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