Effect of azithromycin administration in cases of acute bronchiolitis – A systematic review and meta-analysis

Abstract

Acute Bronchiolitis is the most common viral lower respiratory tract infection in infants requiring hospitalization. Management is usually symptomatic and supportive with no specific treatment options. Although viral, Azithromycin by its anti-inflammatory properties might play a role in improving the clinical outcome. The objective was to assess the effect of azithromycin on length of hospital stay and duration of oxygen requirement in cases of acute bronchiolitis. Data sources such as PubMed and Google Scholar were systematically searched till June 2023. The meta-analysis included all published, randomized controlled trials that investigated the efficacy of Azithromycin over placebo in infants <24 months with acute bronchiolitis. Data extraction was guided by a predetermined checklist. Using RevMan 5 software, the mean length of hospital stay and duration of oxygen administration were pooled from the selected studies. The fixed-effect model was used to compare the length of hospital stay and the duration of oxygen administration in the Azithromycin and placebo group. Data analyses were performed in July 2023. The primary outcome was a comparison of the length of hospital stay in infants with Bronchiolitis receiving either azithromycin (intervention) or placebo (control). The secondary outcome was the assessment of the duration of oxygen requirement in both intervention and control groups.The initial search yielded 601 records of which 68 articles underwent full-text evaluation, which identified four articles and a total of 571 patients that were included. The findings did not favor the usage of azithromycin antibiotic in treatment of acute bronchiolitis (Mean deviation = 1.21, 95% CI 0.53–2.78, P = 0.80). An insignificant Q statistic (P = 0.001) indicated the absence of heterogeneity (I2 = 0%). Length of hospital stay showed an overall insignificant effect as the length of stay is almost similar in both drugs (OR = 1.04 95% CI 0.49–2.23, P = 1.00). An insignificant Q statistic (P = 1.00) indicated the absence of heterogeneity (I2 = 0%).