RCT of Montelukast as Prophylaxis for Upper Respiratory Tract Infections in Children

Author:

Kozer Eran12,Lotem Zachi3,Elgarushe Mahmud4,Torgovicky Rafael5,Cohen Raanan5,Cohen Herman A.26,Berkovitch Matitiahu27

Affiliation:

1. Pediatric Emergency Unit, and

2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;

3. Pediatric Ambulatory Center, Clalit Health Services, Ramla, Israel;

4. Clalit Health Services, Ramla, Israel;

5. Merck Sharp & Dohme (MSD) Company, Petah Tikva, Israel; and

6. Pediatric Ambulatory Center, Clalit Health Services, Petah Tikva, Israel

7. Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, Israel;

Abstract

BACKGROUND:Infections with viruses causing upper respiratory tract infection (URI) are associated with increased leukotriene levels in the upper airways. Montelukast, a selective leukotriene-receptor antagonist, is an effective treatment of asthma and allergic rhinitis.OBJECTIVE:To determine whether prophylactic treatment with montelukast reduces the incidence and severity of URI in children.METHODS:A randomized, double-blind, placebo-controlled study was performed in 3 primary care pediatric ambulatory clinics in Israel. Healthy children aged 1 to 5 years were randomly assigned in a 1:1 ratio to receive 12-week treatment with 4 mg oral montelukast or look-alike placebo. Patients were excluded if they had a previous history of reactive airway disease. A study coordinator contacted the parents by phone once a week to obtain information regarding the occurrence of acute respiratory episodes. The parents received a diary card to record any acute symptoms of URI. The primary outcome measure was the number of URI episodes.RESULTS:Three hundred children were recruited and randomly assigned into montelukast (n = 153) or placebo (n = 147) groups. One hundred thirty-one (85.6%) of the children treated with montelukast and 129 (87.7%) of the children treated with placebo completed 12 weeks of treatment. The number of weeks in which URI was reported was 30.4% in children treated with montelukast and 30.7% in children treated with placebo. There was no significant difference in any of the secondary variables between the groups.CONCLUSIONS:In preschool-aged children, 12-week treatment with montelukast, compared with placebo, did not reduce the incidence of URI.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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