Antibiotics for Acute Wheezing and Asthma Exacerbations: An EAACI Position Paper and Systematic Review

Antibiotics are frequently prescribed in preschool wheezing episodes and acute asthma exacerbations (AAEs), even though antibiotics are not recommended as standard AAE treatment.

To systematically present relevant literature about the clinical effects of antibiotics for AAE and conclude with recommendations.

Systematic search was conducted in Medline ALL, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials. Primary outcomes included AAE duration and length of hospital stay, while secondary outcomes incorporated AAE severity, treatment failure, AAE recurrence risk, spirometry, health costs, and adverse events.

Randomised controlled trials and cohort studies were included if they investigated the clinical effect of antibiotics in AAE compared to placebo/standard care.

Fifteen studies were included. Evidence for clinical effects of antibiotics in AAE treatment is scarce. Macrolides seem to shorten AAE duration in children; for adults, there is a lack of data. Antibiotics were associated with a longer hospital admission in retrospective observational studies, without evidence in randomised trials. Procalcitonin-guided treatment led to a reduction of antibiotic prescriptions without adverse outcomes.

Limited evidence is available that macrolides shorten AAE duration in preschool wheezers. For other age groups, there is no clear evidence of beneficial effects of antibiotics.