The most recent Global Initiative for Asthma (GINA) report does not recommend a role for antibiotics in management of asthma exacerbation unless there is strong evidence of lung infection, such as fever and purulent sputum or radiographic evidence of pneumonia. This is supported by recent trials involving azithromycin (a commonly prescribed antibiotic for management of asthma), which found that this drug had no statistically significant impacts on severity of symptoms during an exacerbation. One small randomised controlled trial (RCT) in young children with recurrent asthma-like symptoms showed that azithromycin reduced the duration of asthma-like symptoms. No RCT has been conducted in children who have a diagnosis of asthma to determine if the rate of severe asthma exacerbation or the severity of asthma symptoms or duration of an asthma exacerbation is reduced by azithromycin. A potential role for azithromycin in reducing the duration of an episode of asthma-like symptoms in children less than 3 years of age requires further investigation. Antibiotic treatment in addition to its lack of efficacy also increases the risk of bacteria resistance for those on long term treatment regimes.
Brusselle GG, Vanderstichele C, Jordens P, et al. Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial. Thorax. 2013;68(4):322-9.
2018 GINA Report, Global Strategy for Asthma Management and Prevention.
Li H, Liu DH, Chen LL, et al. Meta-analysis of the adverse effects of long-term azithromycin use in patients with chronic lung diseases. Antimicrob Agents Chemother. 2014;58(1):511-7.
Johnston SL, Szigeti M, Cross M, et al. Azithromycin for Acute Exacerbations of Asthma The AZALEA Randomized Clinical Trial. JAMA Intern Med. 2016;176(11):1630–1637.
Stokholm J, Chawes BL, Vissing NH, et al. Azithromycin for episodes with asthma-like symptoms in young children aged 1-3 years: a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2016;4(1):19-26.