Archive | 2021
The efficacy and safety of azithromycin in treatment for childhood asthma: a systematic review and meta-analysis
Abstract
Background: Evidence suggests controversial results based on the\nantibacterial and anti-inflammatory effects of azithromycin (AZI) in the\ntreatment of childhood asthma. This study was to further evaluate the\nefficacy and safety of AZI in childhood asthma. Methods: We searched\nPubMed, Embase (via Ovid), Cochrane Library, China National Knowledge\nInfrastructure, Chinese Scientific Journals database, WANFANG, and\nChinese Biomedical Literature database from inception to November 11,\n2020. Randomized controlled trials (RCTs) of AZI versus placebo or one\npositive control drug, AZI plus anti-asthma drugs (AADs) versus the same\nAADs, and AZI plus AADs versus placebo or one positive control drug plus\nthe same AADs were included. Primary outcomes were number of\nexacerbations (NoE); score of clinical tools to assess asthma control\nafter treatment; number of days to relieve symptoms with β2 agonist\n(DBA); post-treatment lung function indicators, including FEV1% of\npredicted value (pFEV1%), FVC% of predicted value (pFVC%), FEV1/FVC%\nof predicted value (pFEV1/FVC%), and PEF% of predicted value (pPEF%).\nSecondary outcomes were post-treatment fractional exhaled nitric oxide\n(FENO); post-treatment eosinophil counts in sputum (sEOS) or blood\n(bEOS); author self-reported outcomes related to asthma (AROs); and\nadverse events (AEs). Results: 61 eligible reports from 59 studies were\nfinally included. AZI plus AADs shows no statistically significant\ndifference in NoE (RR = 0.49; 95% CI, 0.07 – 3.26; P = 0.05) and sEOS\n(MD = -1.13%; 95% CI, -3.54% – 1.29%; P = 0.36) compared to AADs\nalone. The post-treatment C-ACT score was improved after AZI plus\nsalmeterol and fluticasone (SF) treatment compared to SF alone (MD =\n2.97; 95% CI, 2.39 – 3.54; P < 0.001). Results from three\nstudies which could not be meta-analyzed showed that AZI may reduce DBA\ncompared to placebo. AZI combined with AADs could improve post-treatment\npFEV1% (AZI + glucocorticoid (GC) vs GC: MD = 6.92%; 95% CI, 1.47%\n– 12.37%; P = 0.01. AZI + leukotriene receptor antagonist (LTRA) vs\nLTRA: MD = 24.88%; 95% CI, 21.47% – 28.29%; P < 0.001.\nAZI + GC + BA vs GC + BA: MD = 12.40%; 95% CI, 9.72% – 15.08%; P\n< 0.001), pFEV1/FVC% (AZI + GC vs GC: MD = 10.24%; 95% CI,\n6.44% – 14.03%; P < 0.001. AZI + GC + BA vs GC + BA: MD =\n9.05%; 95% CI, 5.66% – 12.44%; P < 0.001. AZI + BA vs\nLTRA + BA: MD = 14.48%; 95% CI, 11.84% – 17.12%; P <\n0.001), and pPEF% (MD = 7.00%, 95% CI, 2.53% – 11.47%; P = 0.002),\nbut not improve pFVC% (MD = -10.37; 95% CI, -20.86% – 0.12%; P =\n0.05), compared to AADs alone. Post-treatment bEOS was significantly\nhigher in the AZI group than in the traditional Chinese medicine\ncompound granules group (MD = 0.07×109/L; 95% CI, 0.05×109 – 0.09×109;\nP < 0.001). No statistically significant difference in bEOS\nafter treatment with AZI plus montelukast (MON) and loratadine (LOR)\ncompared to MON and LOR (MD = 0.03×109/L; 95% CI, -0.06×109 –\n0.12×109; P = 0.50). Meanwhile, AZI combined with AADs did not increase\nAEs (RR = 0.76; 95% CI, 0.51 – 1.13; P = 0.17). Conclusions: AZI was\nbeneficial in improving some clinical symptoms and lung functions in\nchildhood asthma. AZI did not increase AEs when combined with AADs.