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A recent study published in the New England Journal of Medicine found azithromycin did not lead to a greater reduction in symptom severity among young children presenting to the emergency department (ED) with moderate-to-severe wheezing. The study included 840 children aged 18–59 months—62% of which tested positive for potentially pathogenic airway bacteria, and 86.1% had detectable respiratory viruses. Rhinovirus was the most common (72.5%). In the study, conducted at 8 U.S. pediatric EDs, children received either azithromycin or placebo for 5 days. Symptom severity scores using the Asthma Flare-up Diary for Young Children scale over those 5 days were nearly identical between groups. In children who tested positive for pathogenic bacteria, median symptom scores were 9.59 with azithromycin vs 9.72 with placebo. Among those who tested negative, scores were 9.30 with azithromycin vs 9.10 with placebo. Rates of hospitalization, ED length of stay, return visits, and adverse events were also similar between groups. Although azithromycin increased bacterial clearance (58.7% vs 11.4%), this did not translate into clinical improvement, according to researchers.
No real benefit: While previous studies have produced mixed results, the authors of this study concluded that azithromycin should not be used routinely for preschool children with moderate-to-severe wheezing. It’s also important to note that the trial was stopped early for futility because interim analysis showed that the treatment was unlikely to work, thus exposure to azithromycin was halted.