Antibiotics for asthma attacks: masking uncertainty. Issue 1 (1st July 2021)

• Record Type: Journal Article
• Authors: Ramakrishnan, Sanjay; Couillard, Simon
• Is Part Of: European respiratory journal. Volume 58:Issue 1(2021)
• Publication Date: 2021-07-01
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.00183-2021
• Languages: English
• ISSNs: 0903-1936

Abstract

The role for antibiotics in acute asthma has been historically overestimated [1]. From a mechanistic point of view, multiplex PCR testing and conventional microbiological techniques show that >50–80% of events are associated with viral infections, and less than 20% associated with evidence of bacterial infection, with the remaining proportion presumed to be due to allergies and irritants [2]. Consequently, antibiotics are not expected to work in the context of most asthma attacks and their routine use is not recommended. This stance is supported by a Cochrane review, which found inconsistent data to support antimicrobial use [3] and a good quality retrospective cohort study, which associated the combination of antibiotics and oral corticosteroids (OCS) with a longer hospital length of stay, higher hospital cost, and similar risk of treatment failure compared to matched patients treated only with OCS alone [4]. Despite current guidelines advising against, GPs commonly prescribe antibiotics with steroids for asthma attacks. The uncertainty caused by a symptom-based management paradigm probably drives this. A biology-guided management paradigm is needed. https://bit.ly/3iS3CCd