Antibiotics are no help in severe asthma: study

But they are associated with a longer hospital stay, higher costs and increased risk of diarrhoea

Antibiotic therapy in patients with severe asthma flares has been shown to provide no additional benefit, according to the results of a large retrospective US analysis in JAMA Internal Medicine.


Guidelines do not recommend antibiotics for patients hospitalised with an asthma exacerbation — unless there are clear signs of infection.

However, a previous study has suggested 41% of patients receive antibiotics on day one, says the retrospective's lead author Dr Mihaela Stefan, from the University of Massachusetts Medical School-Baystate in Springfield, Massachusetts.

In the analysis, researchers looked at more than 19,800 adults hospitalised for asthma exacerbation and treated with systemic corticosteroids between 2015 and 2016.

Forty-four per cent were started on an antibiotic during the first two days of their hospital stay.

These patients were older (median age 48), and more likely to be white (49% vs 41%) and smokers (7% vs 5%), and they had more comorbidities than their peers who did not start an antibiotic.

In a propensity score-matched analysis, antibiotic therapy was not associated with better patient outcomes (odds ratio for risk of treatment failure, 0.82 to 1.11).

It was, however, associated with a 29% longer length of hospital stay, higher hospital costs and increased risk of antibiotic-related diarrhoea.

There was no between-group difference in readmission rates at 30 days.

"These findings are novel, reflect the experience of unselected patients cared for in routine settings, and lend strong support to current guidelines that recommend against the use of antibiotics in the absence of concomitant infection,” Dr Stefan and colleagues wrote.

“In addition, the findings highlight the need for future research to improve antimicrobial stewardship in the setting of asthma.”

More information: JAMA Internal Medicine 2019.