Inappropriate Antibiotic Use for Asthma Flare-Up Common and Costly With No Apparent Benefit

May 24, 2018

By Megan Brooks

NEW YORK (Reuters Health) - Unnecessary antibiotic use in adults hospitalized for asthma exacerbation without lung infection is common and associated with increased length of stay and risk for antibiotic-related diarrhea, with no apparent benefit, a new study shows.

"Inappropriate use of antibiotics is a public-health problem given the risk of bacterial resistance and of antibiotic-related adverse events," Dr. Mihaela Stefan of the University of Massachusetts Medical School, in Springfield, told Reuters Health.

"Asthma exacerbations are an important cause for recurrent hospitalizations and restricting the use of antibiotics to only those who may benefit is important. Our results strengthen the evidence that antibiotics should not be prescribed routinely in adult patients hospitalized with asthma," Dr. Stefan said by email.

The study was presented May 22 at the American Thoracic Society International Conference in San Diego.

Clinical guidelines, including the Global Initiative for Asthma, state that current evidence does not support a role of antibiotics for asthma exacerbation unless there is strong evidence of lung infection (fever or purulent sputum or radiographic evidence of pneumonia).

In a prior study, Dr. Stefan and colleagues found that 60% of patients without an indication of lung infection were treated with antibiotics.

In the largest observational comparative effectiveness study to date, Dr. Stefan and colleague reviewed the medical records of adults hospitalized for asthma exacerbation and treated with corticosteroids over two years (2015-2016) at 554 U.S. hospitals. They excluded patients with any potential reason for receiving antibiotics, including being diagnosed with a sinus infection, pneumonia, bronchitis, emphysema, sepsis or any other condition that should be treated with antibiotics.

Among the remaining 22,043 patients, 46% were treated with an antibiotic during the first two days of their hospital stay. These patients were somewhat older (mean age, 51 vs. 47 years), more likely to be white (50% vs. 42%) and smokers (8% vs. 6%), and had a higher number of comorbid conditions, relative to those who were not put on antibiotics.

Compared with patients who did not receive an antibiotic, those who did had longer hospital stays (mean 4.4 vs. 3.4 days, P<0.0001) yet similar treatment-failure rates (5.6% with and without antibiotics).

In a propensity-matched analysis, receipt of antibiotics remained associated with longer time spent in the hospital, higher cost of hospitalization (mean cost $6,427 vs. $5,387), and a significantly increased risk of antibiotic-related diarrhea (odds ratio, 1.55), but not with an increased risk of treatment failure.

"Multivariable adjustment and hierarchical modeling to account for possible confounders and the hospital effect, as well as several sensitivity analyses yielded similar results," the researchers write in their meeting abstract.

“All hospitals should assess their practice in caring for patients hospitalized with asthma and increase their antibiotic stewardship," Dr. Stefan said in a conference statement.

She told Reuters Health, "Interventions to reduce inappropriate antibiotic prescribing for hospitalized patients with asthma are needed to decrease antibiotic overuse and bacterial resistance."

Dr. Stefan said her research group is planning a qualitative study to get a better handle on why patients hospitalized with an asthma flare-up without evidence of lung infection are given antibiotics.


American Thoracic Society International Conference 2018.

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