Asthma exacerbation in hospitalized children: routine early antibiotics do little

  • Okubo Y & al.
  • J Allergy Clin Immunol
  • 3 Jun 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Routine, nonempirical antibiotic use offers no benefit and lengthens hospital stay among children hospitalized for asthma exacerbation.
  • These results are from a large retrospective cohort study of almost 50,000 children.

Why this matters

  • Antibiotics should not be routinely prescribed in children hospitalized for asthma exacerbation.
  • This study provides further support for professional society guidelines that recommend against routine use of antibiotics.

Study design

  • Retrospective analysis of data from an inpatient database (N=48,743), University of Tokyo (2010-2018).
  • 41% of the cohort received antibiotics in the absence of infection, and the remainder received no antibiotics.
  • The primary outcome was length of hospital admission.
  • Funding: Ministry of Health, Labour, and Welfare, Japan.

Key results

  • Based on propensity score matching analysis, with early antibiotics vs no antibiotics:
    • Longer hospitalization: mean difference, 0.21 (95% CI, 0.17-0.25) days.
    • Higher hospitalization costs: mean difference, $83.50 (95% CI, $62.90-$104.00) USD.
    • Higher risk for probiotic use to combat antibiotic-associated diarrhea: risk ratio, 2.01 (95% CI, 1.81-2.23).
  • Groups did not differ in treatment failure (need for mechanical ventilation) or 30-day readmission.

Limitations

  • Single-center.
  • Retrospective, observational.