Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2005 Massachusetts Medical Society. All rights reserved.

Azithromycin for recurrent respiratory tract infections? Not yet! ▸

Recurrent respiratory tract infections (RRTIs) are a common pediatric problem and often result in additional physician visits and time lost from school or work. Viruses most often cause these infections, but some infections may be due to the atypical bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae. Researchers investigated the presence of these “atypicals” and examined the role of azithromycin in treatment for RRTIs.

To determine the presence of atypical bacteria, 352 patients aged 1 to 14 years with an acute respiratory infection and a history of RRTIs were compared with 208 age- and sex-matched healthy controls. Recurrent RRTI was defined as eight or more episodes per year in children younger than 3 years and six or more per year in older children. Atypical bacteria were identified in 54% of patients and only 4% of controls.

The patient group was randomized to receive azithromycin (10 mg/kg/day 3 times weekly for 3 weeks) plus supportive care, or supportive care alone. At the 1-month follow-up exam, the azithromycin-treated group had a clinical success rate—defined as complete resolution of the acute symptoms present at enrollment and no reappearance of any clinical RRTI symptoms—of 96.6%, compared with 82.3% in the group not given antibiotics. The difference in success rates was significant only in azithromycin-treated patients who had proven atypical bacterial infections. At 6 months, however, all azithromycin-treated patients, regardless of bacterial infection status, had a significantly better success rate (defined as no more than two respiratory relapses) than did supportive-care patients (63.5% vs. 52.1%).

Comment ▸

These authors should be applauded for investigating a possible new RRTI therapy that challenges existing dogma. However, this trial, which was sponsored by the maker of …