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Clinical bottom lines
Macrolides are not justified in children with mild-to-moderate asthma, given the inconsistent evidence of clinical benefit and risk of antimicrobial resistance (grade B).
Macrolides might be helpful in children with severe multi-treatment-refractory asthma (grade C)
An 8-year-old boy with poorly controlled asthma presents to respiratory clinic. Two months ago, he had an asthma exacerbation while outside the UK and was prescribed azithromycin. His mother has continued giving it to him, as she feels it improves his respiratory symptoms.
Structured clinical question
In children with asthma (population), is adjunctive macrolide therapy (intervention) beneficial in treating exacerbations and/or persistent uncontrolled symptoms (outcomes)?
A Cochrane library search for ‘macrolides’ AND ‘asthma’ AND ‘children’ resulted in two relevant systematic reviews.1 2 Search of MEDLINE via PubMed using the keywords ‘macrolide OR erythromycin OR azithromycin OR clarithromycin OR telithromycin OR fidaxomicin OR troleandomycin OR spiramycin’ AND ‘asthma OR wheeze’ AND ‘children OR paediatric’ identified 13 additional systematic reviews, 4 relevant,3–6 as well as 34 clinical trials, 7 relevant. …
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