Early Azithromycin in the Treatment of Respiratory Illness may Prevent the Development of Severe Lower Respiratory Tract Illness in Preschool Children

Background Wheezing is prevalent in early childhood, with 14%-26% of preschoolers presenting with recurrent wheezing during the first 6 years of life.1 Many children with recurrent acute episodes of severe lower respiratory tract infection (LRTI) are eventually diagnosed with asthma,2 but studies have demonstrated a lack of effectiveness of traditional asthma therapy for many of these children.3 The authors identified a need to find a novel treatment to reduce the severity of these episodes, given the substantial morbidity in unscheduled physician's office and urgent care visits, emergency department treatment, and hospitalizations.2 Although respiratory viruses are frequently detected in nasopharyngeal secretions obtained during these acute episodes,4,5 bacteria have also been found.6,7 Though not recommended by the current asthma guidelines, antibiotics are often used in clinical practice during respiratory tract infections (RTIs) and asthma exacerbations.8,9 Methods The researchers conducted a randomized controlled, double-blind parallel group trial with 607 children from 9 US medical centers between April 2011 and December 2014, with a follow-up period of 78 weeks. Previous publications have shown improvement in symptom scores and lung function with early treatment of acute asthma episodes with telithromycin in adults,10 as well as a decrease in neutrophilic inflammation in recurrently wheezing preschool children treated with clarithromycin.11 Studies have also demonstrated a decrease in serum and upper airway IL-8 levels and recurrent wheeze in infants with respiratory syncytial virus treated with azithromycin.12 However, the study failed to demonstrate a difference in the secondary outcome measures of frequency of unscheduled visits to physicians' offices, urgent care, and the emergency department.