Not enough evidence on whether antibiotics given to people with acute asthma (without evidence of infection) is effective

Patients with acute asthma who require admission to hospital are often treated with antibiotics, in case the underlying cause of the attack is a bacterial infection. This review examines the evidence regarding this therapy and whether it is justified in patients where x-rays and other diagnostic parameters do not indicate a bacterial infection. A limited number of studies were identified by searches conducted and data from them were extracted and analysed. The review concludes that whilst there may be little evidence to support the use of antibiotics in the treatment of acute asthma, more work is required for specific patient subgroups, notably older patients.

Authors' 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.

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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: 

We searched the Cochrane Airways Group Specialised Register to identify randomised controlled trials. In addition, bibliographies were checked and authors and pharmaceutical companies were contacted. The most recent search was carried out in March 2005.

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, we identified two trials 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 participants in this review was 97, but values were recorded for 115 exacerbations.

An update search conducted in March 2005 did not identify any further studies.

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