LAUSR

Researchers conducted a double-blinded study where participants were randomised after medical review to receive an oral 3-day course of placebo or 20 mg/kg azithromycin when they had an episode of asthma-like symptoms lasting at least 3 days. Participants were children aged 1–3 years who were known to have recurrent asthma-like symptoms, recruited from the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. A total of 158 episodes (affecting 151 children) were randomised. The primary outcome, mean duration of the episode post-treatment, was 3.4 days for children receiving azithromycin versus 7.7 days for children receiving placebo. This result is an impressive reduction. However, asthma-like symptoms were defined in the study as ‘troublesome lung symptoms’ consisting of cough, wheeze or dyspnoea and only 18% of participants objectively had wheeze when assessed by a paediatrician at randomisation. It is therefore quite possible that many had an alternative cause for their symptoms such as a benign, self-limiting upper respiratory tract infection. As macrolide use can alter intestinal and respiratory tract flora for several months at least, they may detrimentally alter the ecology of colonising microbial organisms in our population if used in a widespread fashion. Furthermore, concerns have been raised that azithromycin use might greatly increase a toddler’s subsequent likelihood of being diagnosed with asthma at 5 years of age. It is therefore difficult to conclude at this stage that the benefits of azithromycin for pre-school wheeze outweigh disadvantages.