Giving azithromycin to children with a history of recurrent severe lower respiratory tract illness may reduce the severity of further episodes, a randomised double blind placebo controlled trial reports.

Published in JAMA the study randomised 607 children aged 12-71 months with a history of recurrent severe lower respiratory tract infection to receive azithromycin (12 mg/kg/day) for five days or placebo at the onset of symptoms that had previously led to a wheezing espisode. 

A total of 937 respiratory tract infections were experienced by 443 children in the study, including 92 severe episodes.

A significantly lower risk of progressing to a severe lower respiratory infection was seen in the children given azithromycin than in those given placebo (absolute risk for first respiratory tract infection in the azithromycin group was 0.05, compared with 0.08 in the placebo group; hazard ratio 0.64 (95% confidence interval 0.41 to 0.98); P=0.04).

Azithromycin was well tolerated and had low rates of treatment related adverse effects, the researchers reported. 

“Children who demonstrate an azithromycin response, as reflected by less severe episodes of respiratory tract infection, may benefit from repeating such therapy with subsequent illnesses,” they concluded.

However an accompanying editorial warned that more widespread azithromycin use for a condition as common as early intermittent childhood wheezing would increase the prevalence of macrolide resistance.

“Until a higher risk population can be prospectively identified (rather than all children with intermittent wheezing associated with viral recurrent tract infection) for progression to severe lower respiratory tract infection, the consequences of widespread use of azithromycin, both known and hypothesized, outweigh the benefit for most children,” they wrote.