Τίτλος:
A real-life comparative effectiveness study into the addition of
antibiotics to the management of asthma exacerbations in primary care
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background Asthma exacerbations are major contributors to asthma
morbidity and mortality. They are usually managed with bronchodilators
and oral corticosteroids (OCS), but clinical trial evidence suggests
that antibiotics could be beneficial. We aimed to assess whether
treatment of asthma exacerbations with antibiotics in addition to OCS
improved outcomes in larger, more representative routine-care
populations.
Method A retrospective comparative effectiveness study into managing
asthma exacerbations with OCS alone versus OCS plus antibiotics was
conducted using the Optimum Patient Care Research Database. The dataset
included 28637 patients; following propensity score matching 20 024
adults and 4184 children were analysed.
Results Antibiotics in addition to OCS were prescribed for the treatment
of asthma exacerbations in 45% of adults and 32% of children. Compared
to OCS alone, OCS plus antibiotics was associated with reduced risk of
having an asthma/wheeze consultation in the following 2 weeks (children
hazard ratio (HR) 0.84 (95% CI 0.73-0.96), p=0.012; adults HR 0.86
(95% CI 0.81-0.91), p<0.001), but an increase in risk of a further OCS
prescription for a new/ongoing exacerbation within 6 weeks in adults (HR
1.11 (95% CI 1.01-1.21), p=0.030), but not children. Penicillins, but
not macrolides, were associated with a reduction in the odds of a
subsequent asthma/wheeze consultation compared to OCS alone, in both
adults and children.
Conclusion Antibiotics were frequently prescribed in relation to asthma
exacerbations, contrary to guideline recommendations. Overall, the
routine addition of antibiotics to OCS in the management of asthma
exacerbations appeared to confer little clinical benefit, especially
when considering the risks of antibiotic overuse.
Συγγραφείς:
Murray, Clare S.
Lucas, Sarah J.
Blakey, John
Kaplan, Alan
and Papi, Alberto
Paton, James
Phipatanakul, Wanda
Price,
David
Teoh, Oon Hoe
Thomas, Mike
Turner, Steve and
Papadopoulos, Nikolaos G.
Περιοδικό:
European Respiratory Journal
Εκδότης:
EUROPEAN RESPIRATORY SOC JOURNALS LTD
DOI:
10.1183/13993003.03599-2020
