Azithromycin for Pediatric Critical Asthma: A Multicenter Retrospective Cohort Study

Area of Science:

• Pediatric critical care medicine
• Pharmacology and therapeutics
• Respiratory medicine

Background:

• Azithromycin (AZI) is sometimes prescribed for pediatric critical asthma (CA), but its use and impact in this population are not well-characterized.
• There is a lack of trial-derived efficacy and safety data for AZI in children hospitalized for CA.

Purpose of the Study:

• To analyze the prescribing trends of azithromycin (AZI) in children hospitalized for critical asthma (CA).
• To evaluate the clinical outcomes associated with AZI use in this pediatric population.

Main Methods:

• A multicenter, retrospective cohort study was conducted using the Pediatric Health Information Systems registry.
• Data from children aged 3-17 years hospitalized for CA between January 2011 and December 2022 were analyzed.
• Exclusion criteria targeted alternative indications for AZI; outcomes included prescribing rates, patient demographics, CA treatments, and inpatient outcomes.

Main Results:

• Azithromycin was prescribed to 20.7% of 47,797 children with CA, showing a downward trend from 34.7% in 2011 to 12.4% in 2022.
• Children receiving AZI were older and had a more severe clinical course, indicated by higher rates of bilevel positive airway pressure, invasive ventilation, extracorporeal life support, and longer hospital stays.
• Median institutional AZI prescribing rates varied significantly, ranging from 5.6% to 60%.

Conclusions:

• Despite the absence of supporting efficacy or safety data, azithromycin was prescribed to a significant proportion of children hospitalized for critical asthma between 2011 and 2022.
• The observed trend indicates a decrease in AZI prescribing over the study period.
• Children who received AZI exhibited more severe disease trajectories, highlighting the need for further investigation into its appropriateness and impact in pediatric critical asthma.