Azithromycin Does Not Prevent Recurrent Wheeze After RSV
Azithromycin use does not prevent recurrent wheeze in infants and young children following severe respiratory syncytial virus (RSV) bronchiolitis, according to the results of a double-blind, placebo-controlled study.1
Included were 200 patients aged 1- to 18-months who were hospitalized with RSV bronchiolitis during the RSV seasons from 2016 to 2018 at St. Louis Children’s Hospital.
After consideration of recent open-label antibiotic use, participants were randomized to receive oral azithromycin or placebo. The azithromycin dose was 10 mg/kg daily for 7 days, followed by 5 mg/kg daily for 7 days.
The occurrence of recurrent wheeze, the primary outcome, was defined as a third episode of post-RSV wheeze in the following 2 to 4 years. The biologic activity of azithromycin was measured by the participants’ nasal wash interleukin-8 levels.
The results indicated that the risk of post-RSV recurrent wheeze was not reduced by azithromycin use, as 47% of the azithromycin group and 36% of the placebo group had post-RSV recurrent wheeze. The azithromycin group had lower nasal wash interleukin-8 levels at day 14 after randomization (P < .01).
Azithromycin use did not impact the risk of recurrent wheeze among patients who were taking other antibiotic treatments. However, patients who were antibiotic-naïve who received azithromycin may have an increased risk of recurrent wheeze.
“Azithromycin therapy for 14 days during acute severe RSV bronchiolitis did not reduce recurrent wheeze occurrence over the following 2 to 4 years,” the researchers concluded. “Our data suggest no benefit of azithromycin administration with the goal of preventing recurrent wheeze in later life.”
—Leigh Precopio
Reference:
- Beigelman A, Srinivasan M, Goss CW, et al. Azithromycin to prevent recurrent wheeze following severe respiratory syncytial virus Bronchiolitis. NEJM Evidence. Published online February 27, 2022. doi:10.1056/EVIDoa2100069