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Does antibiotic treatment improve outcomes for patients with asthma exacerbations?
Antibiotic therapy is commonly prescribed to patients with acute exacerbations of asthma, despite scarce evidence and consensus guidelines advocating limited prescribing. Stefan and colleagues (JAMA Intern Med 2019; E1-E7: doi:10.1001/jamainternmed.2018.5394) investigated the outcomes of antibiotic therapy in hospitalised patients with asthma exacerbations treated with corticosteroids using a retrospective cohort study design. Data were collected from an administrative database in the USA. A propensity score matched analysis was conducted in an attempt to minimise the influence of confounding factors. Additionally, exposure to antibiotics was assessed in the first 2 days of admission to avoid association of subsequent deterioration. The authors included 19 811 adults from 542 acute care hospitals. Patients with a potential indication for antibiotics (eg, COPD, bronchiectasis, pneumonia, etc) were excluded. In the first 2 days of hospital admission, 8788 patients (44.4%) received antibiotics. The median hospital stay in those treated with antibiotics was 4 (3–5) days, compared with 3 (2–4) days in those untreated (p<0.001). Treatment failure rates in the whole cohort was low (5.6%) and did not differ between the groups. Rates of antibiotic-associated diarrhoea were low (1.4% treated vs 1.1% untreated). Suggested mechanisms for the prolongation of the hospital stay include unmeasured confounders (mitigated by trial design) and patients not being discharged until they had completed their course of antibiotics. These results support the current recommendations for limited antibiotic prescribing in non-infective asthma exacerbations and …
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