Should Antibiotics Be Used In The Treatment of Asthma?

The question of using antibiotics for the treatment of asthma is one that physicians often hear raised by their patients. Routine antibiotic use is not recommended by the guidelines, as the etiology of the attack is most often not bacterial, but rather viral or allergic. It is important to remember that yellow sputum can be caused by the presence of eosinophils.

A recent article in the New England Journal suggested some benefit from the use of telithromycin. However it may be that the improvement seen by patients in this study was not from the antibacterial effect of the drug, but rather from an as yet unidentified anti-inflammatory effect of the drug. At this time it is recommended that antibiotics only be used in the treatment of asthma when there are signs of concomitant infection i.e. sinusitis, pneumonia, otits media.

A systematic review of the evidence for using antibiotics in patients with asthma exacerbations either routinely or when the suspicion of bacterial infection is minimal suggested no benefit from the use of antibiotic treatment. It is important to remember that inappropriate prescribing of antibiotics is a major cause of the emergence of drug resistant organisms.

- John Hickey

Thanks to Dr. Andrew McIvor for reviewing the draft copy of this article. Dr. McIvor is Professor of Medicine McMaster University, Staff Respirologist Firestone Institute for Respiratory Research St Joseph's Healthcare Hamilton, Ontario

References:

Use of antibiotics to treat asthma exacerbations. National Asthma Education and Prevention Program - J Allergy Clin Immunol - 01-NOV-2002; 110(5 Suppl): S180-3 (Level 2 evidence)

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