Effect of Azithromycin Administration in Reducing the Risk of Subsequent Wheezing Episodes and Hospital Readmission in Infants with AB

1 Dec, 20

Introduction

A relevant proportion (30-40%) of infants hospitalised for acute bronchiolitis (AB) in the first year of life present recurrent wheezing episodes after the first hospital admission.

Aim

To test the hypothesis that administration of azithromycin during hospitalisation for AB reduces the risk of subsequent wheezing episodes and hospital readmission, independent of the viral aetiology

Patient Profile

Infants less than 12 months of age hospitalised with AB

Methods

A randomised, double-blinded, placebo?controlled trial

Families were contacted by telephone at 3 and 6 months after the initial acute event and answered to a standardised questionnaire in order to identify recurrent wheezing and hospital readmissions

Results

Table 1: Baseline clinical characteristics of analysed patients to follow-up

	Azithromycin	Placebo	P-value
Age at enrollment, months, mean	3.26	3.14	0.843
Weight at enrollment, kg, mean	5.72	5.85	0.749
Gender, boys, n	22	21	0.720
Use of ?2 agonist, n	9	11	0.405
Hypoxemia at admission, n	37	33	1.000
Positive for any virus	20	22	0.288
Positive for RSV, n	17	21	0.182
Duration of hospitalisation, days	5.32	5.85	0.464

Positive samples for RSV were found in 65 of the 104 (62%) of randomised patients
Other viruses identified were Parainfluenza (N=10), Influenza (N=15) and Adenovirus (N=3)
In the patients included in the secondary follow-up analysis, Respiratory Syncytial Virus (RSV) was identified in 38/70 (54.3%) of patients

The recurrence rate of wheezing in the azithromycin group was significantly lower than in the placebo group in patients contacted 3 months after hospitalisation

Figure 1: Risk of recurrent wheezing and hospital readmission after acute bronchiolitis

Conclusion

Azithromycin administered during AB hospitalisation resulted in the reduction of recurrent wheezing episodes; however, this effect is not sustained at six months after AB hospitalisation.

Reference

J Bras Pneumol. 2020;46(3): e20180376