Antibiotics for acute asthma

Abstract

Background: Antibiotics are often prescribed to patients who are admitted to hospital with acute asthma. Their exacerbation is often precipitated by a viral upper respiratory infection (URTI), but in some instances antibiotics are prescribed in spite of questionable efficacy. A lack of strong evidence either to support or to refute the use of treatments in acute asthma leaves room for discussion and debate as to how effective antibiotics are in an acute setting. This review assesses what evidence is available.

Objectives: To determine the efficacy of antibiotics prescribed in the treatment of acute asthma

Search strategy: Electronic databases (MEDLINE, EMBASE and CINAHL) were searched to identify all possible randomised control trials.

Selection criteria: Only RCTs or quasi RCTs were eligible for inclusion. Studies were included if patients were treated for acute asthma in the ED or its equivalent with antibiotics or placebo. Two reviewers independently assessed articles for potential relevance, final inclusion, and methodological quality.

Data collection and analysis: Two reviewers completed trial quality assessment and data extraction independently.

Main results: From 128 potential studies, two trials were identified for inclusion in the review. Both trials reported numbers of exacerbations and not patient numbers due to re admissions over the course of the trials. The total number of patients in this review was 97, but values were recorded for 115 exacerbations.

Reviewer's conclusions: The role of antibiotics in the treatment of acute asthma is difficult to assess from the current literature. Recommendations regarding antibiotic use in acute asthma will remain consensus driven until more research is conducted which includes larger numbers of patients.