Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan.
Department of Pediatrics, Tokai University Hachioji Hospital, Hachioji, Japan.
Int Arch Allergy Immunol. 2022;183(6):617-627. doi: 10.1159/000521192. Epub 2022 Jan 24.
Although current guidelines recommend against routine antibiotic prescription for acute exacerbation of bronchial asthma, children with acute exacerbation of asthma receive antibiotic treatment more frequently. In addition, those antibiotics are often prescribed only for exacerbation of asthma without concurrent bacterial infection.
To clarify the association between antibiotic treatment and bacterial colonization in acute exacerbation of asthma, we investigated whether or not antibiotics affect the clinical condition, laboratory findings, and pharyngeal bacterial colonization in those patients.
Potential bacterial pathogens were investigated in pharyngeal samples of 111 children with acute exacerbation of asthma (mean/median age: 2.8/2.6 years old, respectively). We collected clinical data, such as the duration of wheezing and antibiotic use, and measured the peripheral white blood cell counts, C-reactive protein, and serum levels of total and allergen-specific IgE.
Antibiotics were used in 50.5% patients with acute asthma exacerbation and included cephalosporin, penicillin, macrolide, and others. Episodes of wheezing were significantly longer in patients with antibiotic treatment than in those without it (6.7 ± 3.6 days vs. 6.0 ± 3.1, p = 0.044). Similarly, episodes of wheezing were significantly longer in moderate exacerbation patients with antibiotics than in those without them. Furthermore, in patients with Streptococcus pneumoniae, antibiotic treatment was associated with an extended duration of wheezing in cases of acute moderate exacerbation (7.0 ± 2.4 days vs. 4.8 ± 4.1, p = 0.043).
These results suggest that antibiotic treatment in acute exacerbation of asthma might lead to longer asthmatic symptoms, specifically in patients with pharyngeal S. pneumoniae colonization.
尽管目前的指南建议不要常规开抗生素治疗支气管哮喘急性发作，但哮喘急性发作的儿童接受抗生素治疗的频率更高。此外，这些抗生素通常仅在没有合并细菌感染的哮喘发作时开具。
为了阐明抗生素治疗与哮喘急性发作时细菌定植之间的关系，我们调查了抗生素治疗是否会影响这些患者的临床状况、实验室检查结果和咽部细菌定植。
我们对 111 例哮喘急性发作患儿（平均/中位数年龄分别为 2.8/2.6 岁）的咽部分泌物进行了潜在细菌病原体检测。我们收集了临床数据，如喘息持续时间和抗生素使用情况，并测量了外周白细胞计数、C 反应蛋白和总 IgE 及过敏原特异性 IgE 水平。
50.5%的哮喘急性发作患儿使用了抗生素，包括头孢菌素、青霉素、大环内酯类和其他抗生素。使用抗生素的患儿喘息发作时间明显长于未使用抗生素的患儿（6.7±3.6 天比 6.0±3.1 天，p=0.044）。同样，中度发作的患儿在使用抗生素时喘息发作时间也明显延长。此外，对于肺炎链球菌定植的患儿，抗生素治疗与急性中度发作时喘息时间延长有关（7.0±2.4 天比 4.8±4.1 天，p=0.043）。
这些结果表明，哮喘急性发作时使用抗生素可能会导致哮喘症状延长，特别是在咽部分泌物存在肺炎链球菌定植的患儿中。
