Azithromycin for Pediatric Critical Asthma: A Single-Center Retrospective Cohort Study

Abstract Background: For children hospitalized for critical asthma (CA) in the pediatric intensive care unit, there is practice of administering macrolide antibiotics for a posited anti-inflammatory effect concomitant to systemic corticosteroids. Objective: This study aimed to characterize the prescribing trends for azithromycin (AZI) among children hospitalized for CA and examine differences in clinical features and outcomes. Materials and Methods: We performed a single-center, retrospective cohort study at an academic pediatric referral center from October 2020 to December 2022, including children 3–17 years hospitalized for CA without alternative indications for AZI. The primary outcome was AZI prescribing rate. The secondary outcomes were demographics, asthma-related historical variables, length of stay (LOS), in-hospital mortality, and adjunct CA pharmaceutical and respiratory interventions. Descriptive and comparative statistics were employed. Results: Of 216 children studied, 28 (13%) were prescribed AZI. Compared with those not prescribed AZI, those in receipt experienced a greater LOS (3.7 ± 1.4 vs. 2.5 ± 1.2, P < 0.001), mean continuous albuterol duration (1.5 ± 1.2 vs. 0.9 ± 0.8 days, P < 0.001), and co-exposure rates for noninvasive respiratory support with high-flow nasal cannula (57.1% vs. 31.4% P = 0.01) and bilevel positive airway pressure (46.4% vs. 19.7% P = 0.003). The rates of pharmacological adjunct interventions, invasive ventilation, extracorporeal support, and mortality were comparable. Conclusions: In this single-center study, 13% of children hospitalized for CA were prescribed AZI as an anti-inflammatory adjunct. Use of AZI was more common among those with elevated markers of severity of illness. Furthermore, future research studies must delineate mechanisms of action, identify ideal treatment populations, and assess efficacy and safety endpoints for AZI in pediatric CA.