Azithromycin Therapy Does Not Reduce Recurrent Wheeze After RSV

MONDAY, March 14, 2022 (HealthDay News) — Azithromycin therapy during acute severe respiratory syncytial virus (RSV) bronchiolitis does not reduce recurrent wheeze over two to four years, according to a study published online Feb. 27 in NEJM Evidence.

Avraham Beigelman, M.D., from the Washington University School of Medicine in St. Louis, and colleagues enrolled 200 otherwise healthy 1- to 18-month-old children hospitalized with RSV bronchiolitis. Participants were randomly assigned to receive either oral azithromycin (10 mg/kg daily for seven days, followed by 5 mg/kg daily for seven days) or placebo.

The researchers found that at day 14 after randomization, azithromycin-treated participants had lower nasal wash interleukin-8 levels, which indicated biologic activity of azithromycin. Azithromycin did not reduce the risk for post-RSV recurrent wheeze during the following two to four years, despite evidence of biologic activity (47 versus 36 percent in the azithromycin versus placebo groups; adjusted hazard ratio, 1.45; 95 percent confidence interval, 0.92 to 2.29; P = 0.11). The risk for recurrent wheeze was also not modified by azithromycin among participants already receiving other antibiotic treatment at the time of enrollment (hazard ratio, 0.94; 95 percent confidence interval, 0.43 to 2.07). A potential signal for an increased risk for recurrent wheeze was seen among antibiotic-naive participants who received azithromycin (hazard ratio, 1.79; 95 percent confidence interval, 1.03 to 3.1).

“This is an important message to be communicated to pediatricians, since antibiotics are frequently given to patients with RSV bronchiolitis despite the fact that this practice is not supported by clinical guidelines,” Beigelman said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry.

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