Enough With The Azithromycin Already

It isn't a magical cure for all respiratory tract illnesses.

Up to a quarter of preschool wheezing illnesses are treated with antibiotics – but to what end?

Preschoolers are full of bugs – swabs find both common bacteria and common viruses. In patients with moderate-to-severe wheezing, then, in theory, could that inflammatory process be attenuated by clearing out the bacteria with our favorite indiscriminate antibiotic – azithromycin?

Nope.

It’s an interesting study – and does a nice job splitting their cohort into two chunks: two-thirds of wheezing preschoolers who tested positive for nasopharyngeal carriage of pathogenic bacteria, and a third of whom did not. Virtually all children also tested positive for viruses, predominantly rhinovirus. Approximately half of children enrolled were unwell enough to require brief hospitalization.

Regardless of bacteria “positive” or “negative” status, azithromycin administration did not change the course of symptom improvement when added to the rest of supportive care:

Ultimately, the study was stopped early for futility at interim analysis.

The authors also do note these data do not invalidate other data in which azithromycin was administered at the first sign of a wheezing illness – a different population whose inflammatory process has not fully manifested. But, for the rest of us – just put the antibiotics away!