Azithromycin to Prevent Recurrent Wheeze Following Severe Respiratory Syncytial Virus Bronchiolitis.

Autor:	Beigelman A; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis.; Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel and the Tel Aviv University, Petach Tikvah, Israel., Srinivasan M; Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Goss CW; Division of Biostatistics, Washington University School of Medicine, St. Louis., Wang J; Division of Biostatistics, Washington University School of Medicine, St. Louis., Zhou Y; Department of Medicine, University of Connecticut School of Medicine, Farmington, CT., True K; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Ahrens E; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Burgdorf D; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Haslam MD; City of St. Louis Department of Health, St. Louis., Boomer J; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS., Bram S; Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Burnham CD; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis., Casper TJ; Department of Pediatrics, Mercy Children's Hospital, St. Louis., Coverstone AM; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Kanchongkittiphon W; Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Kuklinski C; Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis., Storch GA; Division of Pediatric Infectious Disease, Department of Pediatrics, Washington University School of Medicine, St. Louis., Wallace MA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis., Yin-DeClue H; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS., Castro M; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS., Schechtman KB; Division of Biostatistics, Washington University School of Medicine, St. Louis., Bacharier LB; Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville.
Jazyk:	angličtina
Zdroj:	NEJM evidence [NEJM Evid] 2022 Apr; Vol. 1 (4). Date of Electronic Publication: 2022 Feb 27.
DOI:	10.1056/evidoa2100069
Abstrakt:	Background: Early-life severe respiratory syncytial virus (RSV) bronchiolitis is a risk factor for childhood asthma. Because azithromycin may attenuate airway inflammation during RSV bronchiolitis, we evaluated whether it would reduce the occurrence of post-RSV recurrent wheeze. Methods: We prospectively enrolled 200 otherwise healthy 1- to 18-month-old children hospitalized with RSV bronchiolitis in this single-center, double-blind, placebo-controlled study and randomly assigned them to receive oral azithromycin (10 mg/kg daily for 7 days, followed by 5 mg/kg daily for 7 days) or placebo. Randomization was stratified by recent open-label antibiotic use. The primary outcome was the occurrence of recurrent wheeze, defined as a third episode of post-RSV wheeze over the following 2 to 4 years. Results: As an indication of the biologic activity of azithromycin, nasal wash interleukin-8 levels, at day 14 after randomization, were lower among azithromycin-treated participants (P<0.01). Despite evidence of biologic activity, azithromycin did not reduce the risk of post-RSV recurrent wheeze (47% in the azithromycin group vs. 36% in the placebo group; adjusted hazard ratio, 1.45; 95% confidence interval [CI], 0.92 to 2.29; P=0.11). Azithromycin also did not modify the risk of recurrent wheeze among participants already receiving other antibiotic treatment at the time of enrollment (hazard ratio, 0.94; 95% CI, 0.43 to 2.07). There was a potential signal among antibiotic-naïve participants who received azithromycin to have an increased risk of recurrent wheeze (hazard ratio, 1.79; 95% CI, 1.03 to 3.1). Conclusions: Azithromycin therapy for 14 days during acute severe RSV bronchiolitis did not reduce recurrent wheeze occurrence over the following 2 to 4 years. Our data suggest no benefit of azithromycin administration with the goal of preventing recurrent wheeze in later life. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT02911935.).
Databáze:	MEDLINE
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