Antibiotic Treatment of Wheezing in Children With Asthma: What Is the Practice?

Kozyrskyj, Anita L.; Dahl, Matthew; Ungar, Wendy J.; Becker, Allan B.; Law, Barbara

doi:10.1542/peds.2005-2443

Cited by 42 publications

(35 citation statements)

References 44 publications

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“…Taken together, this results in two studies with doubtful results [38,39], three studies in which the association disappeared after correcting for RC [3,40,42], and eight that found a positive association that could not be explained by RC [41,[43][44][45][46][47][48][49].…”

Section: Reverse Causationmentioning

confidence: 52%

“…Finally, in three other studies, the associations between antibiotic use and asthma remained after adequate adjustment for infections [44,45,47].…”

Section: Confounding By Indicationmentioning

confidence: 89%

“…In three of these studies [3,40,42], initially positive associations between antibiotic use and wheeze or asthma disappeared after correction, whereas in the fourth study [41] the association between antibiotic use and wheeze remained after correcting for RC. RC as an explanation was unlikely in six studies that had ensured that exposure (antibiotic use) and follow-up periods took place subsequently and were not overlapping [43][44][45][46][47][48]. Furthermore, ALM et al [49] found an increased risk of wheeze in the first year of life after antibiotic use in the first days after birth.…”

Section: Reverse Causationmentioning

confidence: 99%

“…Several of the eight studies mentioned previously (RC excluded) did not collect relevant information about the indication for antibiotic prescription or episodes of infections at the time of antibiotic exposure [41,43,48,49], whereas the other studies did [44][45][46][47]. The study by KUSEL et al [46] illustrates why CbI should be taken into account.…”

Section: Confounding By Indicationmentioning

confidence: 99%

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Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

Penders¹,

Kummeling²,

Thijs³

2011

European Respiratory Journal

128

108

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Our aim was to systematically review and meta-analyse longitudinal studies on antibiotic use and subsequent development of wheeze and/or asthma with regards to study quality, outcome measurement, reverse causation (RC; wheezing/asthma symptoms have caused prescription of antibiotics) and confounding by indication (CbI; respiratory tract infections leading to antibiotic use may be the underlying cause triggering asthma symptom development).English-language papers and studies published before November 1, 2010 with longitudinal observational design were included. Study quality was assessed using the Newcastle-Ottawa scale.We identified 21 longitudinal studies. The effect of antibiotic use on wheeze/asthma risk varied between studies. 18 studies were eligible for meta-analysis showing pooled OR 1.27 (95% CI 1.12-1.43) for wheeze/asthma. When we eliminated studies with possible RC and CbI, the pooled risk estimate in the nine remaining studies was attenuated to OR 1.12 (95% CI 0.98-1.26). Definition of wheeze/asthma and age at follow-up differed between studies. Three studies focused on wheeze/ asthma beyond 5-6 yrs of age with the presence of active symptoms and/or medication (pooled OR 1.08, 95% CI 0.93-1.23; dominated by one study).RC and CbI lead to overestimation of the association between antibiotic use and subsequent development of wheeze/asthma. Association was weak when fully adjusted for these types of bias. Heterogeneity of disease definition between studies could affect the results.

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Section: Reverse Causationmentioning

confidence: 52%

“…Finally, in three other studies, the associations between antibiotic use and asthma remained after adequate adjustment for infections [44,45,47].…”

Section: Confounding By Indicationmentioning

confidence: 89%

Section: Reverse Causationmentioning

confidence: 99%

Section: Confounding By Indicationmentioning

confidence: 99%

See 2 more Smart Citations

Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

Penders¹,

Kummeling²,

Thijs³

2011

European Respiratory Journal

128

108

View full text Add to dashboard Cite

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“…Although this figure is more than double the rate we found in emergency-department settings, that study did not evaluate whether comorbid diagnoses may have accounted for some antibiotic prescribing as other studies also have failed to do. [25][26][27][28][29] Accounting for comorbidities was shown to be important by Vanderweil et al's 30 study of a sample of adults and children, which demonstrated that accounting for secondary diagnoses does reduce the proportion of visits with unjustified antibiotic prescriptions during emergency-department visits for asthma.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

et al. 2011

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OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68–4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05–3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26–0.89]). A second multivariate analysis of only office-based visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24–0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.

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Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses

Bacharier

Guilbert

Mauger

et al. 2015

JAMA

247

161

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IMPORTANCE Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness pathogenesis. Strategies that effectively attenuate such episodes are needed. OBJECTIVE To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episodes. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled, parallel-group trial conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute’s AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by December 2014. Participants were 607 children aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment. INTERVENTION Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days; n = 307) or matching placebo (n = 300), started early during each predefined RTI (child’s signs or symptoms prior to development of LRTI), based on individualized action plans, over a 12-through 18-month period. MAIN OUTCOMES AND MEASURES The primary outcome measure was the number of RTIs not progressing to a severe LRTI, measured at the level of the RTI, that would in clinical practice trigger the prescription of oral corticosteroids. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures. RESULTS A total of 937 treated RTIs (azithromycin group, 473; placebo group, 464) were experienced by 443 children (azithromycin group, 223; placebo group, 220), including 92 severe LRTIs (azithromycin group, 35; placebo group, 57). Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo (hazard ratio, 0.64 [95% CI, 0.41-0.98], P = .04; absolute risk for first RTI: 0.05 for azithromycin, 0.08 for placebo; risk difference, 0.03 [95% CI, 0.00-0.06]). Induction of azithromycin-resistant organisms and adverse events were infrequently observed. CONCLUSIONS AND RELEVANCE Among young children with histories of recurrent severe LRTIs, the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI. More information is needed on the development of antibiotic-resistant pathogens with this strategy.

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Antibiotic Treatment of Wheezing in Children With Asthma: What Is the Practice?

Abstract: Antibiotic use for wheezing in children declined in the 1990s, but the increased use of broader spectrum macrolides has implications for antibiotic resistance. A link between antibiotic prescribing and physician specialty and location of training identifies opportunities for intervention.

Cited by 42 publications

References 44 publications

Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses

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