Asthma: acute exacerbation: no clear benefit from antibiotics

Clinical bottom line (level 1b-)

  1. Patients admitted with acute severe asthma who received antibiotics compared with placebo did not clearly improve more quickly or get discharged sooner.
  2. There was no clear effect on peak expiratory flow rates (PEFR).
Graham et al: Lancet 1982; (1): 418-420
Expires November 2002

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, UK

60 patients (aged mean 39, 58% female) admitted to hospital with 71 acute asthma exacerbations (FEV 1 < 1.5l or PEFR < 150 ml/min)

Excluded if
  • changes of pneumonia on chest X-ray
  • penicillin allergy
Control Group: (n = 30, 29 analysed): placebo
Experimental Group: (n = 30, 29 analysed): amoxacillin 500 mg three times a day
All patients received oral or intravenous steroids throughout their hospital stay. Patients had regular beta-agonists and/or phosphodiesterase inhibitors.
97% followed for 25 days

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
length of hospital stay 8 days
() 		7 days
() 		not significant
( to )
time to 50% improvement in PEFR 2 days
() 		2 days
() 		not significant
( to )
PEFR at discharge 73 ml/min
() 		59 ml/min
() 		p-value: 0.052
( to )

Comments

  1. The study is too small to exclude potential benefit or harm from taking antibiotics.
  2. There is no easy strategy to decide when to give antibiotics in asthma. Routine administration is not useful.

Citation

  1. Graham VA, Milton AF, Knowles GK, et al: Routine antibiotics in hospital management of acute asthma. Lancet 1982; (1): 418-420
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer: Mitsuhiro Kamei

Clinical Question.
Patient acute severe asthma
Intervention or Exposure antibiotics
Comparison placebo
Outcome recovery, discharge from hospital, PEFR