This type of asthma is triggered by physical activity. ((bronchial$ or respiratory or airway$ or lung$) adj3 (hypersensitiv$ or hyperreactiv$ or allerg$ or insufficiency)).mp. Figure 3 provides an overview of our risk of bias judgements. Issue 9. Batham S, We received detailed data tables and the statistical analysis plan from the lead study author. Konstantinou GN, Four studies reported asthma symptoms, but we were able to combine results for only two macrolide studies of 416 participants; the MD in diary card symptom score was 0.34 (95% confidence interval (CI) 0.60 to 0.08), with lower scores (on a 7 point scale) denoting improved symptoms. FonsecaAten 2006 excluded children with a diagnosis of bacterial infection needing antibiotics. Other types of drugs that directly alter the immune system are sometimes used for people with severe asthma, but most people do not need immunomodulators. The apparent gulf between guidelines and actual clinical practice, the large numbers of patients treated with antibiotics for acute exacerbations of asthma, and the growing necessity of careful antibiotic stewardship, as well as cost considerations, all highlight the importance of providing a clear overview of the best available evidence on use of antibiotics for acute exacerbations of asthma. But bacterial infections seem to make up a small percentage of flare-ups. When inhaled, it will cause your airways to narrow slightly. Wheeze in this age group generally is not considered to be the same entity as asthma, Study involved children with chronic rather than acute asthma, Randomized controlled study within the ABC cohort (Asthma Begins in Childhood), Participants in the ABC cohort study. Comparison 1 Antibiotics versus placebo/usual care, Outcome 3 Serious adverse events. official website and that any information you provide is encrypted Clinic pulmonary function tests were secondary outcomes, On a centrally randomised basis with use of computergenerated codes, participants were assigned in a 1:1 ratio, Participants were assigned in a 1:1 ratio to receive oral telithromycin (two 400 mg capsules daily) or placebo (2 capsules identical in appearance) for 10 days. It is interesting to note that Graham 1982 reported the proportion of participants who had received antibiotic treatment during the week before admission (24.3% in the treatment arm and 17.6% in the control arm); this was an exclusion criterion for most of the included studies. A large portion of the data was not presented in the study papers in a format compatible with the other studies, or simply was not reported. Kozyrskyj AL, Keep reading to learn how antibiotics work and what researchers have found so far. The three studies in children applied varied inclusion criteria, ranging from one to 18 years of age. It is characterised by wheeze, cough, chest tightness, and shortness of breath. Bacterial infections can be confirmed by laboratory tests, for example, blood tests; however, these are not always available in primary care (at the GP). In a 2017 study that examined medical files from 100 hospitalized women, researchers found that respiratory infections caused almost three-quarters of asthma flare-ups. Mallia P, (2018). Bacterial infections may require treatment with antibiotics. Dunleavy A contributed to protocol revision, drafted discussion. Data for adults and children were subgrouped throughout and were reported separately above. Kew KM, These studies included a total of 681 adults and children who were randomly assigned to comparisons of interest in this review. We then planned to use the following outcomes in subgroup analyses. Three studies recruited only children (age range 1 to 18, depending on the specific study (FonsecaAten 2006; Koutsoubari 2012; Shapiro 1974)), two recruited only adults (age range 17 to 68, and 18 to 55 years; Johnston 2006; Johnston 2016), and one included adolescents and adults (age range 14 to 82; Graham 1982). Interventions: intervention, comparison, concomitant medications, and excluded medications. Dunleavy A, Excluding this trial had minimal impact on the effect estimate (OR 1.00, 95% CI 0.69 to 1.45; participants = 462; studies = 2; I2 = 0%; data not shown). Monthly searches of Allied and Complementary Medicine (AMED) EBSCO. They are also used for upset stomachs and as . US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov). Antibiotic guidance for primary care: for consultation and local adaptation, assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/664740/Managing_common_infections_guidance_for_consultation_and_adaptation.pdf. The predominant symptom is wheeze, but people with asthma also experience cough, chest tightness, and shortness of breath. Vinding RK, Four studies investigated macrolide antibiotics (FonsecaAten 2006; Johnston 2006; Johnston 2016; Koutsoubari 2012), and two studies investigated ampicillin and amoxicillin, respectively (Graham 1982; Shapiro 1974); both studies were conducted over 30 years ago. In some cases, you . Camargo C, For serious adverse events, Koutsoubari 2012 reported that no participant required hospital admission during the study; as the definition of a serious adverse event is "death, a lifethreatening adverse event, inpatient hospitalisation or prolongation of existing hospitalisation", we assumed that no participant had experienced an SAE. Reslizumab (Cinqair). British guideline on the management of asthma. Black PN, Furthermore, it would be considered unethical to withhold antibiotics from an individual with a strongly suspected bacterial infection, so it is unlikely that trials will be carried out in this cohort, for whom antibiotics are already recommended. Antibiotics may be administered or prescribed in a primary care setting, if the exacerbation was not severe enough to warrant immediate hospital admission, or in an emergency department (ED) or inpatient setting in the context of a more severe exacerbation. We updated the protocol including the background, PICO, and methods (, American Academy of Allergy, Asthma and Immunology (AAAAI), Asia Pacific Society of Respirology (APSR), British Thoracic Society Winter Meeting (BTS), International Primary Care Respiratory Group Congress (IPCRG), Thoracic Society of Australia and New Zealand (TSANZ), Primary endpoints were comparison of nasal cytokine and chemokine concentrations, and serum cytokines, between the 2 arms. drug A vs placebo and drug B vs placebo) had been combined in the same metaanalysis, we planned to either combine the active arms or halve the control group to avoid doublecounting. Therefore we have low confidence in the effect estimates. Different antibiotics were given in each study. More data for symptom score and PEFR were missing, Several outcomes (health status at followup (6 weeks); need for additional medications (e.g. September 2016, britthoracic.org.uk/documentlibrary/clinicalinformation/asthma/btssignasthmaguideline2016/, Annual report of the chief medical officer, volume two, infections and the rise of antimicrobial resistance, media.dh.gov.uk/network/357/files/2013/03/CMOAnnualReportVolume220111.pdf. the contents by NLM or the National Institutes of Health. Chawes BL, Correspondence with lead author confirmed all participants, trial personnel, and outcome assessors were masked throughout, No specific details were given in the trial report regarding outcome assessor blinding. Furthermore, most participants were recruited at a hospital, rather than in a primary care setting, and this may limit generalisability to other settings, for example, primary care. Antibiotic resistance is when drugs designed to kill certain strands of bacteria stop being effective. This review aims to clarify the evidence around use of antibiotics in patients who present with an acute exacerbation of asthma. It has been estimated that more than 300 million people are affected by asthma worldwide (GAN 2014). 14. Huchings MI, et al. Eggleston PA, All but one study explicitly excluded participants with a diagnosed, or strongly suspected, bacterial infection and those who had received recent antibiotic therapy (Koutsoubari 2012). Had we identified more studies, we would have had to consider whether pooling older studies using penicillin antibiotics with more recent studies using macrolides made clinical sense. Benadryl vs Claritin This is a non-sedating antihistamine which means it doesn't cross the blood-brain barrier so it doesn't make you tired. These studies included a total of 681 participants who were randomly assigned to comparisons of interest in this review. Jackson DJ, One study used an openlabel design and therefore was at high risk of performance and detection bias (Koutsoubari 2012). The https:// ensures that you are connecting to the The two remaining studies investigated penicillins, specifically, amoxicillin (Graham 1982) and hetacillin (known now as ampicillin) (Shapiro 1974). et al. We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs), and continuous data as mean differences (MDs), all with a fixedeffect model. Ungar WJ, We combined endpoint results at 10 days for Johnston 2006 and Johnston 2016, and results favoured antibiotics over placebo, with the mean difference (MD) exceeding the minimal clinically important difference: mean difference (MD) 23.42 L/min, 95% CI 5.23 to 41.60. Allergen immunotherapy is a promising treatment for allergic diseases that induce immune tolerance through the administration of specific allergens. Espinola JA, those not meeting current guidance to receive antibiotics). In homeopathy, the goal is to treat illnesses such as asthma with a tiny amount of, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. For the other three studies, we judged the risk as unclear. Last medically reviewed on September 15, 2022. Overall these favoured antibiotics, but measures show ambiguity. I2 = 0. Likewise, in a large 2020 study with 110,418 participants, researchers found that people with acute lower respiratory tract infections were overtreated with antibiotics. Members of the trial team managing and analysing the data were also blind to the treatment received. We also acknowledge the assistance of the corresponding authors. 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