Study: Antibiotics Do Not Benefit Asthma Exacerbation Outcomes

Addition of the antibiotic azithromycin to standard treatment of asthma exacerbations in adults was not associated with significant therapeutic benefit, according to the results of a recent trial.

Although current guidelines do not recommend the use of antibiotics for asthma exacerbations, recent research has suggested that they may be associated with clinical benefits. In order to determine whether azithromycin could improve outcomes in patients with asthma, researchers conducted a randomized, double-blind, placebo-controlled clinical trial of 4582 participants with a history of asthma for more than 6 months who had recently experienced a deterioration in asthma control requiring corticosteroids.

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The participants were randomly assigned to either azithromycin 500 mg daily or to placebo.

Of 280 adults planned to receive azithromycin, only 199 were given the drug, with the primary reason for nonrecruitment being the recent receipt of antibiotics. Mean primary outcome asthma symptom scores were 4.14 at exacerbation and 2.09 at 10 days for the azithromycin group and 4.18 and 2.20 for the placebo group, respectively. Overall, there was no significant difference in symptom scores between the groups at day 10, and no significant differences were observed in quality-of-life questionnaire results or lung function.

“In this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit,” the researchers concluded. “For each patient randomized, more than 10 were excluded because they had already received antibiotics.”

—Michael Potts


Johnston SL, Szigeti M, Cross M, et al; AZALEA Trial Team. Azithromycin for acute exacerbations of asthma: the AZALEA randomized clinical trial [published online September 19, 2016]. doi:10.1001/jamainternmed.2016.5664.