Antibiotics May Be Appropriate in Certain Cases of Asthma Exacerbations

In patients with acute asthma exacerbations, treatment with antibiotics is associated with a reduction in symptoms and improvements in pulmonary function, according to meta-analysis results published in the Annals of Emergency Medicine.

Clinical trials databases, including MEDLINE, EMBASE, PsychINFO, and the World Health Organization International Clinical Trials Registry Platform, were searched from inception through October 2017. Investigators identified trials that included adults or children who presented to the outpatient clinic, inpatient ward, or emergency department (ED) with an asthma exacerbation. In addition, only randomized controlled trials with comparisons between patients undergoing antibiotic therapy and controls were included in the final meta-analysis.

The primary outcomes of interest were intensive care unit (ICU) admission, duration of symptoms, mortality, length of hospital admission, relapse, peak flow, and adverse events (eg, nausea, diarrhea, and upper abdominal pain).

A total of 6 studies with 681 adults and children with an acute asthma exacerbation met the study inclusion criteria. The researchers found moderate quality evidence that favored the use of antibiotics for improving peak expiratory flow (mean difference [MD], 23.42; 95% CI, 5.23-41.60) and symptoms (MD, -0.34; 95% CI, -0.60 to -0.08) compared with controls. In 3 studies, there was no difference between antibiotics and controls in terms of all adverse events (odds ratio, 0.99; 95% CI, 0.69-1.43) and serious adverse events (risk difference, 0.00; 95% CI, -0.03 to 0.03). None of the studies reported mortality outcomes.

Limitations of the review were the exclusion of patients who required and were indicated for antibiotic therapy, as well as the relatively small number of studies included in the review.

“Antibiotics may be considered for select patients,” the researchers wrote, “but further work will be needed to best identify those who are most likely to benefit from antibiotics.”

Reference

Ganti L, Rosario J. Do antibiotics improve outcomes in patients with acute asthma exacerbations? [published online April 11, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.02.033