Children who develop severe wheezing and difficulty breathing after a common cold, with a risk of severe lower respiratory tract illness, could benefit from taking a common antibiotic at the first sign of cold symptoms, according to a report in JAMA.
Respiratory infections commonly affect young children. Most recover fairly easily from the typical coughs and congestion, but a significant number develop illnesses severe enough to cause breathing problems, necessitating visits to urgent care clinics or emergency rooms.
In the current study, Dr. Leonard Bacharier and colleagues from Washington University School of Medicine in St. Louis tested the antibiotic azithromycin against placebo in 607 children at nine academic medical centers nationwide.
The children were aged 12 months to 6 years, with histories of developing severe lower respiratory tract illnesses, but otherwise healthy.
Parents of the children were provided with the antibiotic while the children were in good health. Instructions were to begin the course at the earliest signs of cold. Investigators worked with each family to identify a set of early symptoms that would indicate when to begin the treatment.
Less severe illness in those who took azithromycin
Similar numbers of respiratory infections were reported in both groups, but the severity of the infections was different.
Of the 92 illnesses deemed severe because they required oral corticosteroids, 57 were in the placebo group and 35 were in the group receiving azithromycin.
The antibiotic was given at the highest dose approved by the US Food and Drug Administration (FDA) for treating infection in order to maximize the anti-inflammatory effects. However, the role of the dosage level in lowering the level of disease is not clear.
What about antibiotic resistance?
Concerns over antibiotic-resistant organisms led the researchers to do further research on azithromycin resistance in a subset of 86 patients at St. Louis Children's Hospital.
- A doctor should be consulted if body temperature is 100.4 degrees Fahrenheit or more
- Medical advice should be sought if symptoms last more than 10 days
- In case of severe or unusual symptoms, you should visit the doctor.
Some children who received azithromycin during the study had azithromycin-resistant germs in their throats at the end of the study, but azithromycin-resistant bacteria were also observed at almost the same rate in children who did not take the antibiotic.
The effect of azithromycin on antibiotic resistance is therefore not fully understood, says Dr. Bacharier, suggesting a need for further research into the difference in rates of developing resistance.
He also noted that those children with bacteria resistant to azithromycin did not fare any differently in the study than those without azithromycin-resistant organisms.
Dr. Bacharier adds that about 1 in 6 visits to doctors for asthma symptoms in the US results in the child being prescribed an antibiotic, usually after the episode has become severe.
He expressed the need for prudence in antibiotic use, but if children are having severe episodes for which there is no effective therapy, they will end up taking antibiotics anyway, but not until they are very sick.
The current study suggests that early intervention can reduce the risk of children developing severe respiratory illnesses before it happens. Even the children who developed severe illnesses while on azithromycin showed less severe symptoms than those who received placebo.
Dr. Bacharier says:
The team also suggests testing the effectiveness of this intervention in children at the "next step of the disease severity ladder," specifically, those who receive daily asthma therapy.
"Oral corticosteroids such as prednisone have become the standard of care for these situations. But there are some studies that suggest these treatments don't consistently work for young children. That's why we want to find ways to prevent upper respiratory infections from progressing to lower respiratory tract illnesses. Once the episode gets going, standard interventions are less effective than would be desired."
Earlier this year, Medical News Today reported that a number of doctors are overprescribing antibiotics for respiratory illness.