No Benefit to Azithromycin in Acute Asthma Exacerbation

Clinical Question:
For patients with acute asthma exacerbations, does the addition of azithromycin improve the resolution of symptoms?

Bottom Line:
These data show no improved outcomes with the addition of azithromycin to
standard treatment for patients with acute asthma exacerbations requiring
systemic steroids. However, the recruitment for this study was difficult,
as half the eligible patients were excluded because of current or recent
use of antibiotics, which resulted in a very underpowered study that only
reached half its recruitment target. For each person included, more than 10
were excluded. Beyond its impact on the study results, the recruitment
difficulty suggests that antibiotic use for asthma exacerbation is
widespread despite current treatment guidelines that recommend otherwise.
(LOE = 1b-)

Reference:
Johnston SL, Szigeti M, Cross M, et al, for the
AZALEA Trial Team. Azithromycin for acute exacerbations of asthma: the
AZALEA randomized clinical trial. JAMA Intern Med 2016 Sep 19. doi:
10.1001/jamainternmed.2016.5664. [Epub ahead of print].

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