Antimicrobial Therapy in Childhood Asthma and Wheezing

Abstract

There is an increasing number of viral and bacterial pathogens suspected of contributing to asthma pathogenesis in childhood, making it more difficult for the practitioner to make specific therapy decisions. This review discusses the role of viruses, e.g. respiratory syncytial virus, human metapneumovirus, influenza viruses and rhinoviruses, as well as the role of the atypical bacteria Chlamydophila pneumoniae and Mycoplasma pneumoniae, as contributors to childhood asthma. Diagnosis, prevention, and therapy are discussed, including a summary of drugs, i.e. macrolide antibacterials, antivirals, and vaccine regimens already available, or at least in clinical trials. For the practitioner dealing with patients every day, drug regimens are assigned to the individual pathogens and an algorithm for the management of atypical infections in patients with asthma or recurrent wheezing is presented.

Human Metapneumovirus and Its Role in Childhood Respiratory Infections

“…In patients with acute HMPV infection high viral loads have been detected in respiratory specimens [93 • -96]. Without any attempt to identify the causative pathogen, many attending physicians decide to administer antibiotics to febrile children with HMPV LRTI [66,97] or with asthma exacerbation due to HMPV infection [98,99]. This common practice represents a misuse of antibiotics and fosters the selection of resistant bacteria.…”