December 2015 Newsline published online ahead of print.

Clinicians can reduce the risk of severe respiratory tract illness in sick children prone to wheezing by administering an antibiotic at the first signs of symptoms, according to research published in JAMA.

Researchers at the Washington University School of Medicine in St. Louis, Missouri, tested azithromycin against a placebo in 607 children aged 12 months to 6 years. Although equal numbers of respiratory infections were reported in both the antibiotic and placebo groups, the investigators found a notable difference in the severity of infections. A total of 92 illnesses were deemed severe – 57 in the placebo group, compared with 35 in the antibiotic group.

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“Oral corticosteroids … have become the standard of care for these situations,” said Leonard B. Bacharier, MD, lead investigator and professor of pediatrics at Washington University. “There are some studies that suggest these treatments don’t consistently work for young children.… Once the episode gets going, standard interventions are less effective than would be desired.”

The researchers worked with the families of each study participant to identify the symptoms of an oncoming respiratory tract illness. Parents were encouraged to administer a course of azithromycin as soon as symptoms were presented.

Concerned over the potential development of antibiotic-resistant organisms, Dr. Bacharier and colleagues studied azithromycin resistance in a subset of 86 study patients at St. Louis Children’s Hospital and noted that a larger study would be necessary to determine whether differing rates of azithromycin resistance are clinically meaningful.

“We want to be prudent with our antibiotic use,” said Dr. Bacharier. “Our study suggests we can reduce the risk of severe respiratory illness by giving azithromycin treatment earlier.”


  1. Bacharier LB, Guilbert TW, Mauger DT, et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses. JAMA. 2015; doi: 10.1001/jama.2015.13896