Azithromycin improves asthma control and reduces exacerbations in kids with poor control, but replication needed

Référence

Ghimire JJ, Jat KR, Sankar J, et al. Azithromycin for poorly controlled asthma in children: a randomized controlled trial. Chest 2022;161(6):1456-1464.

Sommaire

Azithromycin has anti-inflammatory properties as well as antibacterial effects. The researchers in this study identified 120 children, aged 5 years to 15 years, with an Asthma Control Test (ACT) score of 19 points or less, which is consistent with poor control. (A Childhood Asthma Control Test [CACT] result of 19 or less was used for children younger than 12 years). At baseline, there were some imbalances between groups, so ANCOVA was used to adjust for the imbalance in ACT and CACT scores. Children were randomized to receive usual care plus azithromycin 10 mg per kg 3 times a week or usual care alone in an open-label fashion; it does not appear that outcome assessors were masked to treatment assignment. Usual care included and inhaled corticosteroid with or without a long-acting beta agonist and step-up/step-down therapy. The ACT score increased from 15.8 to 18.3 in the control group, and from 14.8 to 21.7 in the azithromycin group (adjusted change 2.4 vs 6.9 points; P < .001). Using the Global Initiative for Asthma definition of good control — an ACT score of greater than 19 points — children in the azithromycin group were more likely to have good control (69.5% vs 18%; P < .001; number needed to treat = 2). Gastrointestinal and skin adverse effects were uncommon and similar between groups. The median number of exacerbations per patient was lower in the azithromycin group (0 vs 1; P < .001 by the rank sum test; it would have been nice to see the actual number of exacerbations in each group).