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DOI: 10.1055/a-1712-4225
Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma
Antibiotikagebrauch bei stationären pädiatrischen Patienten mit akutem, schweren Asthma![](https://www.thieme-connect.de/media/klinpaed/202205/lookinside/thumbnails/1477_10-1055-a-1712-4225-1.jpg)
Abstract
Background Antibiotic use during asthma exacerbations in paediatric patients is not routinely recommended but common practise in out-patient and in-patient settings. Objective of this study was to analyse frequency of antibiotic use during acute severe asthma exacerbations, antibiotic classes utilized and clinical decision-making.
Methods All in-patient admissions over 10 years in a single German Children’s University hospital due to acute severe asthma were included in this retrospective analysis. Age, length of stay, oxygen supplementation, treatment, laboratory parameters and chest x-rays of all patients ranging from 1 to 17 years were analysed.
Results 580 hospital admissions were included in this study. Overall antibiotic use was high but decreased with age (1–5 years 69,6%, 6–11 years 57,6% and 12–17 years 39,7%, p<0.001). Analysis of antibiotic treatment without clear indication showed a consistently lower treatment rate of 28.3%, with macrolides being the most common antibiotic class. Younger age significantly decreased, whereas, increase of CrP value, use of oxygen supplementation and concomitant fever all significantly increased the odds ratio (OR 0.967; 4.366, 2.472 and 2.011 respectively) of receiving antibiotic treatment without clear indication.
Conclusion Antibiotic treatment without clear indication during acute severe asthma is common in this German single-centre cohort. Clinical parameters of more severe disease affect clinician’s decision to administer antibiotics despite evidence of bacterial infection or improved outcome.
Zusammenfassung
Hintergrund Der Einsatz von Antibiotika bei Asthma-Exazerbationen bei pädiatrischen Patienten wird nicht routinemäßig empfohlen, ist aber in der ambulanten und stationären Versorgung gängige Praxis. Ziel dieser Studie war es, die Häufigkeit des Antibiotikagebrauchs während akuter, schwerer Asthma-Exazerbationen, die verwendeten Antibiotikaklassen und die klinische Entscheidungsfindung zu analysieren.
Methoden In diese retrospektive Analyse wurden alle stationären Aufnahmen über 10 Jahre in einer deutschen Universitätskinderklinik wegen akutem, schweren Asthma eingeschlossen. Analysiert wurden Alter, Aufenthaltsdauer, Sauerstoffbedarf, Behandlung, Laborparameter und Röntgenthorax aller Patienten im Alter von 1 bis 17 Jahren.
Ergebnisse 580 Krankenhausaufenthalte wurden in diese Studie eingeschlossen. Der Antibiotikagebrauch war insgesamt hoch, nahm aber mit zunehmendem Alter ab (1–5 Jahre 69,6%, 6–11 Jahre 57,6% und 12–17 Jahre 39,7%, p<0,001). Die Analyse der Antibiotikatherapie ohne eindeutige Indikation zeigte eine niedrigere Behandlungsrate von 28,3%, wobei Makrolide die häufigste Antibiotikaklasse waren. Ein jüngeres Alter, ein Anstieg des CrP-Wertes, die Gabe von Sauerstoff und begleitendes Fieber erhöhten alle signifikant die Odds Ratio (OR 0,967; 4,366, 2,472 bzw. 2,011) für eine Antibiotika-Behandlung ohne klare Indikation.
Schlussfolgerung Eine Antibiotikatherapie ohne eindeutige Indikation bei akutem, schweren Asthma ist in dieser deutschen Kohorte häufig. Klinische Parameter einer schwereren Erkrankung beeinflussen die Entscheidung des ärztlichen Personals, Antibiotika trotz fehlender Anzeichen einer bakteriellen Infektion und fehlender Evidenz für ein verbessertes Outcome zu verabreichen.
Publication History
Article published online:
21 March 2022
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References
- 1 Alcoba G. et al. A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR. Eur J Pediatr 2017; 176: 815-824
- 2 Altenburg J. et al. Immunomodulatory effects of macrolide antibiotics - part 1: biological mechanisms. Respiration 2011; 81: 67-74
- 3 Baan EJ. et al. Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases. BMJ Open 2018; 8: e022979
- 4 Boeck Kde. et al. Coprescription of antibiotics and asthma drugs in children. Pediatrics 2011; 127: 1022-1026
- 5 Doan T. et al. Reduction of Coronavirus Burden With Mass Azithromycin Distribution. Clin Infect Dis 2020; 71: 2282-2284
- 6 Donath H. et al. Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma. Front Pediatr 2020; 8: 562843
- 7 Douglas LC, Choi J, Esteban-Cruciani N. Azithromycin treatment in children hospitalized with asthma: a retrospective cohort study. J Asthma 2020; 57: 525-531
- 8 Ekbom E. et al. Asthma and treatment with inhaled corticosteroids: associations with hospitalisations with pneumonia. BMC Pulm Med 2019; 19: 254
- 9 Fong I. et al. Antibiotic use in children and youths with asthma: a population-based case-control study. ERJ Open Res 2021; 7 (1): 00944-2020
- 10 Gibson PG. et al. Efficacy of azithromycin in severe asthma from the AMAZES randomised trial. ERJ Open Res 2019; 5 (4): 00056-2019
- 11 Jewell MJ. et al. Unnecessary antibiotic prescribing in children hospitalised for asthma exacerbation: a retrospective national cohort study. BMJ Qual Saf 2021; 30: 292-299
- 12 Johnston SL. et al. The effect of telithromycin in acute exacerbations of asthma. N Engl J Med 2006; 354: 1589-1600
- 13 Johnston SL. et al. Azithromycin for Acute Exacerbations of Asthma : The AZALEA Randomized Clinical Trial. JAMA Intern Med 2016; 176: 1630-1637
- 14 Juhn YJ. et al. Increased risk of serious pneumococcal disease in patients with asthma. J Allergy Clin Immunol 2008; 122: 719-723
- 15 Kawasaki Y. et al. Correlation between serum interleukin 6 and C-reactive protein concentrations in patients with adenoviral respiratory infection. Pediatr Infect Dis J 2002; 21: 370-374
- 16 Kozyrskyj AL. et al. Antibiotic treatment of wheezing in children with asthma: what is the practice?. Pediatrics 2006; 117: e1104-e1110
- 17 Neeser OL. et al. A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection. Clin Chem Lab Med 2019; 57: 1638-1646
- 18 Normansell R. et al. Antibiotics for exacerbations of asthma. Cochrane Database Syst Rev 2018; 6: CD002741
- 19 Okubo Y. et al. Recent Practice Patterns and Variations in Children Hospitalized for Asthma Exacerbation in Japan. Int Arch Allergy Immunol 2020; 181: 926-933
- 20 Peltola H, Jaakkola M. Serious bacterial infections. C-reactive protein as a serial index of severity. Clin Pediatr (Phila) 1988; 27: 532-537
- 21 Sadeghdoust M. et al. Effect of azithromycin on bronchial wall thickness in severe persistent asthma: A double-blind placebo-controlled randomized clinical trial. Respir Med 2021; 185: 106494
- 22 Satia I. et al. Emergency department visits and hospitalisations for asthma, COPD and respiratory tract infections: what is the role of respiratory viruses, and return to school in September, January and March?. ERJ Open Res 2020; 6(4): 00593-2020
- 23 Schögler A. et al. Novel antiviral properties of azithromycin in cystic fibrosis airway epithelial cells. Eur Respir J 2015; 45: 428-439
- 24 Simon L. et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39: 206-217
- 25 Stefan MS. et al. Uncertainty as a critical determinant of antibiotic prescribing in patients with an asthma exacerbation: a qualitative study. J Asthma 2020; 1-16
- 26 Stokholm J. et al. Azithromycin for episodes with asthma-like symptoms in young children aged 1-3 years: a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2016; 4: 19-26
- 27 Talbot TR. et al. Asthma as a risk factor for invasive pneumococcal disease. N Engl J Med 2005; 352: 2082-2090
- 28 Vanderweil SG. et al. Inappropriate use of antibiotics for acute asthma in United States emergency departments. Acad Emerg Med 2008; 15: 736-743
- 29 Zeng S. et al. Spiramycin and azithromycin, safe for administration to children, exert antiviral activity against enterovirus A71 in vitro and in vivo. Int J Antimicrob Agents 2019; 53: 362-369