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Azithromycin for acute bronchiolitis and wheezing episodes in children - a systematic review with meta-analysis
Rosa-Maria Ukkonen1, Marjo Renko1,2, Ilari Kuitunen3,4
1Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Insights
Azithromycin may shorten hospitalization for young children with acute bronchiolitis. However, this antibiotic does not prevent wheezing recurrence or reduce intensive care unit needs.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Pharmacology
Background:
- Acute bronchiolitis and wheezing are common in children under two.
- Current treatment guidelines for these conditions vary.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of azithromycin in treating acute bronchiolitis and wheezing in young children.
- To assess azithromycin's impact on hospitalization duration, ICU admission, and wheezing recurrence.
Main Methods:
- Searched PubMed, Scopus, and Web of Science for randomized controlled trials.
- Included studies comparing azithromycin to placebo in children under two years old.
- Analyzed outcomes including wheezing episode progression and recurrence using random-effects models.
Main Results:
- Included 7 studies from 1604 screened abstracts; risk of bias varied.
- Azithromycin showed a moderate-quality evidence for reducing hospitalization duration by 0.27 days.
- Low-quality evidence indicated no significant reduction in ICU treatment needs or wheezing recurrence.
Conclusions:
- Azithromycin may reduce hospitalization time in young children with acute bronchiolitis and wheezing.
- Evidence suggests azithromycin does not prevent wheezing recurrence or reduce ICU admissions.
- Further research with larger sample sizes is needed to confirm clinical utility.
Background:
The aim of this systematic review and meta-analysis was to analyse the efficacy of azithromycin in acute bronchiolitis and wheezing.
Methods:
PubMed, Scopus, and Web of Science databases were searched for randomized controlled trials comparing azithromycin to placebo in children <2 years of age. Main outcomes were progress of acute wheezing episode and recurrence of wheezing. We used random-effects model to calculate mean difference (MD) with 95% confidence interval (CI) or risk ratios (RR) with CI.
Results:
We screened 1604 abstracts and included 7 studies. Risk of bias was low in three and had some concerns in four studies. Need for intensive care unit treatment was assessed in four studies (446 children) and the risk difference was 0.0% (CI -2.0 to 2.0; low quality evidence). Hospitalization duration was -0.27 days shorter in the azithromycin group (MD-0.27, CI -0.47 to -0.07; three studies; moderate quality evidence). Azithromycin did not prevent recurrence of wheezing (RR 0.84, CI 0.45-1.56; three studies), hospital readmissions (RR 1.14, CI 0.82-1.60; four studies).
Conclusions:
We found moderate quality evidence that azithromycin may reduce hospitalization duration. Low certainty evidence suggests that azithromycin does not reduce the need for intensive care unit treatment. Furthermore, azithromycin did not prevent wheezing recurrence.
Impact:
Azithromycin may reduce hospitalization time in acute bronchiolitis and wheezing episodes among children aged less than two. Azithromycin administrated during the acute wheezing period, does not have preventive effect on wheezing recurrence. Azithromycin seemed to have similar adverse event profile than placebo. Future studies with clinically relevant outcomes, and sufficient sample sizes are needed, before implementing azithromycin into clinical use.
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