Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses

The goal of this study was to determine if early administration of azithromycin in preschool children suffering from recurrent lower respiratory tract infections would effective at preventing the progression of the infection.

The study was a randomized, double-blind, placebo controlled parallel study taking place across 9 centers in the US. There were 607 patients, ranging in age from 12-71 months old, with past history of recurrent respiratory infections. Patients either received 12mg/kg daily of azithromycin or a placebo at the onset of infection sympthoms, with the clinical endpoint being the number of infections not progressing to a severe level.

The study concluded that the azithromycin treatment significantly reduced the risk of progression of the infection, with a hazard ratio of 0.64, and a risk difference of developing the first infection between the azithromycin group and the placebo group of 0.03. The patients treated with azithromycin infrequently experienced any adverse side effects from the treatment.

This study is interesting to me because it seems that many respiratory infections can be prevented early on if treated with azithromycin, reducing the suffering of the child and saving the patient and the healthcare system money, which is desirable for all parties. It is also useful to know for a fact that this particular antibiotic is successful in treating these types of infections so that an appropriate drug therapy can be chosen from the start instead of having to try multiple different antibiotics.

Link to Article

Problems and Advice Regarding Appropriate Antibiotic Use for Acute Respiratory Tract Infections in Adults

The most common reason for antibiotic prescription in adults is acute respiratory tract infection (ARTI) and they are often inappropriately prescribed to these patients. This article examines the best practices for antibiotic use and prescription in otherwise health adults showing signs of ARTI.

ARTI includes pharyngitis, uncomplicated bronchitis, and the common cold. The common cold is the most common reason for outpatient physicians to prescribe antibiotics. Antibiotics are prescribed more than 100 million times per year. The innaccurate use of these antibiotics is contributing to antibiotic resistance, which is a very urgent health threat. Antibiotics are responsible for the largest number of adverse effects related to medication use. This article provides evidence for the appropriate prescribing of antibiotics for adults with ARTI to prevent these issues from arising.

This study showed the best guidelines for antibiotic prescription among physicians who see patients for ARTI. Clinicians should not test patients or prescribe antibiotics for patients with bronchitis unless the clinician also suspects pneumonia. It is, in fact, appropriate for clinicians to prescribe antibiotics if streptococcal pharyngitis has been confirmed. Finally, antibiotics should not be prescribed for patients who have a common cold. By following these guidelines, antibiotic overprescribing can be reduced to make for a healthier population. How do you think pharmacists could aid in reducing antibiotic overprescription?

Harris, Aaron M. “Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults.” Ann Intern Med. 2016: M15-1840. http://annals.org/article.aspx?articleid=2481815




Prescription strategies to reduce antibiotic use while controlling symptoms of acute respiratory infections

This study measured symptom duration and severity in patients with acute respiratory infections when given different methods of obtaining antibiotics. One group was given antibiotics and instructed to start their therapy that day. Another group was given no antibiotics. A third group was given a prescription for antibiotics but instructed to only take them if their symptoms do not improve within 3-5 days. The last group was told to pick up a prescription for antibiotics from the physician’s front desk only if their symptoms do not improve within 3-5 days. For each patient, the physician decided which antibiotic would best treat the patient’s respiratory infection. The results showed that the groups with delayed strategies had longer duration of symptoms but reduced use of antibiotics.

JAMA Intern Med. 2016;176(1):21-29.


Because this trial did not focus on a specific acute respiratory infection, it is difficult to determine the consequences of delaying treatment. I know for some infections, delaying treatment may have negative consequences for the patient. I think it is important to realize that the physician has more medical knowledge than the patient. While the patient’s point of view and belief in effectiveness of treatments like antibiotics is important in creating the right treatment regimen, in the delayed strategy, whether or not the patient even starts that treatment is in their hands. The physician should be doing more to advocate to improve the patient’s quality of life.