Utility of adjunctive macrolide therapy in treatment of children with asthma: a systematic review and meta-analysis

Abstract

BackgroundThe purpose of this study was to investigate macrolides as an adjunct to an asthma controller regimen in children with asthma.MethodsProspective clinical trials of macrolide therapy in children with asthma using outcome measures of change in forced expiratory volume in one second (FEV1) and/or oral corticosteroid requirement were searched for in PubMed up to December 2009. The reference lists of studies were also included in the analysis, as well as those listed in published meta-analyses.ResultsThe literature search yielded 116 studies, six of which were included in this meta-analysis. The change in FEV1 from baseline with adjunctive use of macrolide therapy in all children was not significant (0.25% predicted; 95% confidence interval [CI] −0.37, 0.86 predicted, P = 0.43); however, the change in FEV1 among children receiving daily oral corticosteroids was significant (3.89% predicted; 95% CI −0.01, 7.79, P = 0.05). Addition of macrolide therapy to the treatment of children with oral corticosteroid-dependent asthma resulted in a statistically significant decrease in daily corticosteroid dosage (−3.45 mg/day; 95% CI −5.79, −1.09 mg/day, P = 0.004). This reduction in daily corticosteroid dosage was directly proportional to the duration of macrolide therapy (−0.17 mg methylprednisolone per week of macrolide therapy; 95% CI −0.33, −0.021, P = 0.025).ConclusionAddition of macrolides to the treatment regimen of children with oral corticosteroid-dependent asthma improves FEV1 and decreases the daily dosage of corticosteroids required for control in these children. The degree of dose reduction is directly related to the duration of macrolide therapy. Additional large, randomized, placebo-controlled trials of adjunctive macrolide use in children with oral corticosteroid-dependent asthma are required to verify this observation.

New Drugs for Pediatric Asthma

“…Although an official document and a recent pragmatic review do not recommend the routine use of macrolides for children with severe asthma (9, 64), they may be useful for reducing daily oral steroid administration and improving FEV 1 (65), and, for this reason, can be proposed as ex-juvantibus trial in children with neutrophilic asthma (66). In conclusion, further well-designed and large RCTs are warranted before routine use of macrolides is recommended or definitely condemned in pediatric severe asthma.…”

Treating Pediatric Asthma According Guidelines

“…Macrolides have been also proposed in combination to the treatment regimen of asthmatic children, with the aim of decreasing the need of the patient's daily dosage of corticosteroids, due to its antinflammatory and antimicrobial activity ( 49 ). A recent study including 40 school-aged asthmatic children showed that a 3-week course of clarythromicyn given as add-on therapy to regular treatment, was associated with an increased control of symptoms and a decrease in the duration of the asthma exacerbations ( 50 ).…”