HealthDay News — Azithromycin therapy during acute severe respiratory syncytial virus (RSV) bronchiolitis does not reduce recurrent wheeze over 2 to 4 years, according to a study published online February 27 in NEJM Evidence.

Avraham Beigelman, MD, from the Washington University School of Medicine in St. Louis, and colleagues enrolled 200 otherwise healthy 1- to 18-month-old children hospitalized with RSV bronchiolitis. Participants were randomly assigned to receive either oral azithromycin (10mg/kg daily for seven days, followed by 5mg/kg daily for 7 days) or placebo.

The researchers found that at day 14 after randomization, azithromycin-treated participants had lower nasal wash interleukin-8 levels, which indicated biologic activity of azithromycin. Azithromycin did not reduce the risk for post-RSV recurrent wheeze during the following 2 to 4 years, despite evidence of biologic activity (47 vs 36% in the azithromycin versus placebo groups; adjusted hazard ratio, 1.45; 95% CI, 0.92 to 2.29; P =.11). The risk for recurrent wheeze was also not modified by azithromycin among participants already receiving other antibiotic treatment at the time of enrollment (hazard ratio, 0.94; 95% CI, 0.43 to 2.07). A potential signal for an increased risk for recurrent wheeze was seen among antibiotic-naive participants who received azithromycin (hazard ratio, 1.79; 95% CI, 1.03 to 3.1).

“This is an important message to be communicated to pediatricians, since antibiotics are frequently given to patients with RSV bronchiolitis despite the fact that this practice is not supported by clinical guidelines,” Beigelman said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry.

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