The effects of macrolides in children with reactive airway disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

PurposeChildhood reactive airway diseases (RADs) are concerning problems in children’s airways and may be preceded by bronchiolitis and may progress to childhood asthma. The severity of the disease is indicated by deterioration in pulmonary functions, increased usage of rescue medications, and recurrent wheezing episodes. Macrolides have both antimicrobial and anti-inflammatory functions and have been used as adjunctive therapy in childhood RADs.Patients and methodsWe conducted a meta-analysis to evaluate the effect of macrolides in children with RAD. Literature searches were systematically conducted using an electronic database from inception to August 2018. The Cochrane review risk of bias assessment tool was used to assess the quality of each randomized controlled trial.ResultsSixteen randomized controlled trials comprising 1,415 participants were investigated in this meta-analysis. Children treated with macrolide therapy showed significantly better pulmonary functions in both forced expiratory volume in one second (% predicted) (difference in means=−9.77, 95% CI=−14.18 to −5.35, P<0.001; I2=0%) and forced expiratory flow 25–75 (% predicted) (difference in means=−14.14, 95% CI=−26.11 to −2.18, P=0.02; I2=29.56%). In addition, the short-acting β-agonist usage days and recurrent wheezing risk were significantly lowered in children with macrolide treatment (standardized difference in means=−0.34, 95% CI=−0.59 to −0.09, P=0.007, I2=27.05% and standardized difference in means=−0.53, 95% CI=−0.81 to −0.26, P<0.001, I2=0%, respectively). Furthermore, the growth of Moraxella catarrhalis from nasal swabs was less in children treated with macrolides (odds ratio=0.19, 95% CI=0.11–0.35, P<0.001). Children who took macrolides had a lower risk of adverse events (risk ratio=0.83, 95% CI=0.70–0.98, P=0.024, I2=0%).ConclusionThis current meta-analysis suggested that adjunctive therapy with macrolides is safe and effective for achieving better outcomes in childhood RAD.

Azithromycin administered for acute bronchiolitis may have a protective effect on subsequent wheezing

“…Treatment with Azithromycin may decrease the need for short-acting β2-agonists among preschool children with recurrent wheezing. (25) The unique pharmacokinetic properties of Azithromycin might explain the differential effect observed in the risk of post-bronchiolitis wheezing. In general, Azithromycin accumulates in lung tissue, resulting in alveolar macrophages and bronchoalveolar lavage fluid concentrations higher than in serum concentrations.…”

The efficacy and safety of azithromycin in treatment for childhood asthma: A systematic review and meta‐analysis

“…Similar reviews focused on macrolides or the entire population (children and adults). There were some variations in the results among these reviews: macrolides improved lung function in children with asthma, especially FEV 1 was reported most frequently 34–36 . The reviews of the entire population also showed improvement in lung function and symptom scales, but not in the quality of life 15,37–39 .…”

Effect of pidotimod combined with azithromycin on children with mycoplasma pneumonia and the expression levels of IL-10 and G-CSF in serum

“…The results showed that pidotimod combined with azithromycin could significantly decrease the expression levels of IL-10 and G-CSF in serum, effectively kill pathogenic microorganisms and inhibit or resist the growth of pathogenic bacteria; it can also inhibit the release of inflammatory transmitters to reduce the expression of inflammatory factors. The study of Lei et al on the mechanism of sequential treatment of azithromycin combined with Tanreqing on mycoplasma pneumonia in children found that the treatment could significantly downregulate the levels of serum sTREM-1, CK, G-CSF and IL-10, so as to achieve therapeutic effect (36). In the present study, pidotimod also played this role, and the effect of combined drugs was better.…”