Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis 

The antibiotic agent azithromycin was associated with an increased risk for subsequent recurrent wheezing in patients with early-life, severe respiratory syncytial virus (RSV) bronchiolitis. Other antibiotics are likely to have the same harmful effect. “Leave the kids alone,” pleaded the authors of the study.

Recurrent wheezing and asthma often occur after severe RSV bronchiolitis [1]. Aiming to solve this clinical problem, Prof. Avraham Beigelman (Schneider Children's Medical Center of Israel, Israel) and co-investigators developed a randomised trial to analyse whether azithromycin outperformed placebo with respect to recurrent wheezing in hospitalised patients with RSV bronchiolitis (n=200; 1–18 months of age). The primary results did not demonstrate a difference between placebo and azithromycin on recurrent wheezing after an RSV infection [2]. Prof. Beigelman presented the results of a post-hoc analysis of this trial, investigating the influence of non-macrolide antibiotics on the effect of azithromycin on recurrent wheezing [3].

In participants receiving other antibiotics next to azithromycin (30%), there was no difference in the risk for recurrent wheezing between the azithromycin arm and the placebo arm (HR 0.94; 95% CI 0.43–2.07; P=0.88). In contrast, in the no-other-antibiotic-stratum, participants receiving placebo performed better than participants receiving azithromycin (HR 1.79; 95% CI 1.03–3.1; P=0.037). In fact, the study showed that the use of any antibiotic may increase the risk of recurrent wheezing compared with placebo (HR 1.65; 95% CI 1.00–2.72; P=0.048).

“These results indicate that azithromycin, and likely other antibiotic agents, should be avoided during early-life, severe, RSV bronchiolitis,” emphasised Prof. Beigelman. “In our next project, we will investigate whether the harmful effect of antibiotics is due to the impact these medications have on the gut microbiome.”

1. Bacharier LB, et al. J Allergy Clin Immunol. 2012;130(1):91–100.e3.
2. Beigelman A, et al. NEJM Evid. 2022;1(4).
3. Beigelman A, et al. Antibiotic use during severe RSV bronchiolitis may increase subsequent recurrent wheeze risk. ALERT 2, RCT2164, ERS International Congress 2022, Barcelona, Spain, 4–6 September.

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Posted on 30 October 202228 March 2024