Babies with viral infection may respond to antibiotic

Infants with bronchiolitis caused by RSV (respiratory syncytial virus), may benefit from treatment with an antibiotic, according to results of a Turkish study.

Usually occurring in winter, bronchiolitis is the most common respiratory ailment affecting children under two years of age. The virus RSV is the usual cause and treatment has been largely supportive, consisting of supplemental oxygen, intravenous fluids and use of a ventilator if needed. In cases of viral illnesses such as RSV, antibiotics are typically not given.

But because RSV initiates an immune reaction that fuels lung inflammation that may produce long-lasting harmful effects, the Turkish team hypothesized that the course of the disease could be modified and wheezing after bronchiolitis prevented by early treatment with clarithromycin, an antibiotic with anti-inflammatory effects.

To test their hypothesis, Dr. Fulya Tahan and colleagues from Erciyes University School of Medicine, Kayseri, treated 21 infants with RSV bronchiolitis with clarithromycin or inactive placebo for 3 weeks.

They found that children treated with clarithromycin spent significantly less time in the hospital (51 hours vs 88 hours with placebo). Time on supplemental oxygen, intravenous therapy, and bronchodilator therapy was also reduced in the antibiotic arm.

Infants who received the antibiotic were also much less likely to be readmitted to the hospital within 6 months of discharge.

Significant decreases in plasma levels of key inflammatory markers were evident after three weeks of clarithromycin.

“Clarithromycin may be helpful in reducing the short-term effects of RSV bronchiolitis, (which) could be important in reducing subsequent morbidity,” the authors conclude.

“The present study should encourage further studies to confirm the use of clarithromycin in RSV bronchiolitis, especially in infants less than 6 months of age,” they note.

SOURCE: European Respiratory Journal January 2007.

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