SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

11/24/04

Antibiotic in asthma

Summary
Background - There is increasing evidence that bacterial infection is an unusual trigger of asthma exacerbations. Therefore, empiric use of antibiotics (ABx) in the treatment of such exacerbations (formerly done commonly) is now generally considered to be not indicated.

Findings - Beuther and Martin of the National Jewish Medical and Research Center in Denver, CO reviewed current concepts of ABx effects in asthma. Although the large majority of respiratory infections triggering asthma appear to be viral, some evidence suggests that infection with Mycoplasma pneumoniae and Chlamydia pneumoniae play role in promoting airway inflammation that may contribute to asthma pathogenesis. Also, certain ABx may have effects relevant to asthma independent of their anti-bacterial effects. For example, macrolides inhibit catabolism of some corticosteroids leading to enhanced effects of a particular steroid dosage in asthma. However, by mechanisms not well understood, macrolides have additional broad anti-inflammatory properties that may prove useful in the management of asthma and other inflammatory diseases.

Reference
Curr Allergy Asthma Rep 2004;4:132-8

Editor's Comments
Having "grown up" medically in the era when ABx were almost uniformly used as part of the treatment of acute asthma exacerbations, I was always puzzled at this approach when there was no convincing evidence of acute bacterial infection as a trigger. More recently, with the evidence that chronic sinusitis was somehow linked to asthma pathogenesis, some investigators reasoned that ABx treatment would control this sinus infection trigger of asthma. However, there is now even question how often a true bacterial infection is the cause of chronic sinusitis.

Nevertheless, some ABx agents have biologic effects on inflammation independent of their anti-bacterial effects. Some of these effects may be relevant to asthma. Keep tuned!

<-- BACK