Extract
The role for antibiotics in acute asthma has been historically overestimated [1]. From a mechanistic point of view, multiplex PCR testing and conventional microbiological techniques show that >50–80% of events are associated with viral infections, and less than 20% associated with evidence of bacterial infection, with the remaining proportion presumed to be due to allergies and irritants [2]. Consequently, antibiotics are not expected to work in the context of most asthma attacks and their routine use is not recommended. This stance is supported by a Cochrane review, which found inconsistent data to support antimicrobial use [3] and a good quality retrospective cohort study, which associated the combination of antibiotics and oral corticosteroids (OCS) with a longer hospital length of stay, higher hospital cost, and similar risk of treatment failure compared to matched patients treated only with OCS alone [4].
Abstract
Despite current guidelines advising against, GPs commonly prescribe antibiotics with steroids for asthma attacks. The uncertainty caused by a symptom-based management paradigm probably drives this. A biology-guided management paradigm is needed. https://bit.ly/3iS3CCd
Acknowledgements
The authors thank Ian Pavord for his time and insight during manuscript preparation.
Footnotes
Author contributions: S. Ramakrishnan drafted the manuscript and is the guarantor of this publication. S. Couillard contributed to manuscript writing and figure development. Both authors reviewed and approved the final version.
Conflict of interest: S. Ramakrishnan reports grants and non-financial support from Oxford Respiratory NIHR BRC, during the conduct of the study; non-financial support from AstraZeneca, personal fees from Australian Government Research Training Program, outside the submitted work.
Conflict of interest: S. Couillard reports grants and non-financial support from Oxford Respiratory NIHR BRC, during the conduct of the study; grants from Sanofi/Regeneron, personal fees from AstraZeneca, outside the submitted work.
Support statement: This work was supported by the Oxford Respiratory NIHR BRC. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
- Received January 20, 2021.
- Accepted January 21, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org