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After an acute case of RSV bronchiolitis in an infant, azithromycin does not prevent recurrent wheezing

Half of all RSV-infected infants had been diagnosed with asthma by the age of seven, according to Avraham Beigelman, MD, the study's lead author.

This prompted researchers to look into azithromycin, an antibiotic with anti-inflammatory properties, in the hopes of finding a therapeutic drug to prevent recurrent wheezing after an acute RSV infection in children.

The study included 200 babies aged one to eighteen months who had been hospitalized with RSV bronchiolitis for three consecutive RSV seasons (fall 2016–spring 2019). The babies were randomised to azithromycin and stratified based on their use of an open-label non-macrolide antibiotic in the two weeks prior to randomization.

The main outcome was recurrent wheeze, which was defined as a third episode of post-RSV wheeze within the next 2-4 years. Azithromycin’s biological action was tested. The results showed that azithromycin did not diminish the likelihood of post-RSV recurrent wheeze, as 47 percent of the azithromycin group and 36 percent of the placebo group experienced post-RSV recurrent wheeze.

On day 14 after randomization, the azithromycin group had decreased nasal wash interleukin-8 levels. The use of azithromycin had no effect on the probability of recurrent wheezing in patients who were already taking other antibiotics. Patients who were antibiotic-naive and got azithromycin, on the other hand, may have a higher risk of recurrent wheezing.

“Azithromycin therapy for 14 days during acute severe RSV bronchiolitis did not reduce recurrent wheeze occurrence over the following 2 to 4 years,” the researchers concluded. “Our data suggest no benefit of azithromycin administration to prevent recurrent wheeze in later life.”

Dr. Beigelman advised healthcare providers to avoid giving Azithromycin or antibiotics in general to Acute Infant RSV patients since there is a risk of harm.

After an acute case of RSV bronchiolitis in an infant, azithromycin does not prevent recurrent wheezing

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