Objective Low dose, long term macrolide antibiotic therapy is thought to inhibit lymphocyte proliferation, decrease neutrophilic accumulation and decrease IL8 release from eosinophils. Macrolides are thought to decrease corticosteroid requirement in steroiddependent patients and improved pulmonary function test and asthma symptoms .
Methods A retrospective chart review was done to determine if azithromycin had a positive effect in asthma control in children. Azithromycin was started in 10 children aged between 2 and 15 years. All patients were on a high dose of corticosteroids, budesonide 4mgday nebulised and 800gday inhaled n9 or fluticasone propionate 1000gday n1. In addition, all children took a leukotriene antagonist dose tailored for their age and maximum dose of long acting 2 agonist. Seven children were on daily prednisolone and two patients were on subcutaneous terbutaline infusion. Other diagnoses were excluded. Azithromycin 10mgkg was started for 3days a week.
Results A comparison was made 1 year before and after treatment. All patients were on azithromycin during the study period. There was a decrease in hospital admission OR 1.0, 95 CI 1.9 to 0.0, p0.04 and frequency of asthma exacerbations OR 2.9, 95 CI 4.7 to 1.1, p0.005, respectively. We were able to decrease the dose of daily prednisolone in five patients and discontinue in two patients. Overall, eight patientsparents considered an improvement in their over symptoms.
Conclusions Case series such as ours are known to be associated with bias, but the magnitude of effect would suggest a randomised control trial is needed for children with difficult asthma.