Microbes and the Role of Antibiotic Treatment for Wheezy Lower Respiratory Tract Illnesses in Preschool Children
Purpose of Review
Antibiotics are commonly used to treat wheezy lower respiratory tract illnesses in preschoolers, although these infections have been traditionally thought to be predominantly of viral origin. Our purpose is to review recent research pertaining to the role of antibiotics in lower respiratory tract illnesses and on subsequent asthma development, as well as the possible mechanisms of their effects.
Increasing evidence suggests that asthma pathogenesis is associated with events during infancy and early childhood, particularly respiratory tract infections. While viruses are frequently detected in children with lower respiratory tract infections, the presence of potentially pathogenic bacteria is also often detected and may play a role in asthma pathogenesis. Recent evidence suggests that use of macrolides, particularly azithromycin, may decrease the risk of and duration of lower respiratory tract illnesses and prevent future episodes in specific high-risk populations.
Infants and preschoolers who have wheezy lower respiratory tract illnesses have a higher risk of asthma development. Alterations in the microbiome are thought to be influential. While several recent studies identify azithromycin as a therapeutic option in these illnesses, additional research is needed.
KeywordsRecurrent wheezing Bronchiolitis Asthma pathogenesis Antibiotics Macrolides Preschool children
Compliance with Ethical Standards
Conflict of Interest
Dr. Kwong has nothing to disclose. Dr. Bacharier reports grant support from NIH; serving as a consultant to Aerocrine, GlaxoSmithKline, Genentech/Novartis, Cephalon, Teva, Circassia, and Boehringer Ingelheim; serving on advisory boards for Merck, Sanofi, and Vectura; serving on data and safety monitoring boards for DBV Technologies; and receiving honoraria for lectures or continuing medical education development from Aerocrine, GlaxoSmithKline, Genentech/Novartis, Merck, Cephalon, Teva, AstraZeneca, WebMD/Medscape, and Boehringer Ingelheim.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Declaration of Helsinki and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
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