Antibiotics Lengthen Hospitalization, Costs for Asthma Exacerbation Patients

The administration of the treatment to asthma patients is fairly common, despite guidelines advocating against it under certain circumstances.

Mihaela S. Stefan, MD, PhD

Adult patients hospitalized with asthma exacerbations may not benefit from antibiotics if they had no suffered from a previous lung infection. In fact, in some measures, the common treatment may worsen their care.

A new study from researchers at the University of Massachusetts Medical School, presented at the 2018 American Thoracic Society (ATS) International Conference in San Diego, found that adults suffering from asthma exacerbations have lengthened hospitalizations and an increased risk for treatment-related diarrhea when administered antibiotics under poor clinical judgement.

It is largest observational comparative effectiveness study to date, according to the research team, as they analyzed medical records for patients hospitalized for asthma over a 2-year period at 554 US hospitals. The comprehensive research looked into what’s become a disparity between written protocol and common procedure.

“Clinical guidelines, including the Global Initiative for Asthma, state that there is no role for antibiotics in asthma exacerbations unless there is strong evidence of lung infection,” lead study author Mihaela S. Stefan, MD, PhD, a researcher at the university’s Institute for Healthcare Delivery and Population Science, said.

In spite of this, previous studies have indicated that approximately 60% of hospitalized asthma patients received antibiotics without an indication of lung infection.

Patients observed in the study were aged 18 years or older, having been hospitalized with asthma exacerbations between 2015-2016 and treated with systemic corticosteroids.

Researchers defined antibiotic treatment as being initiated during the first 2 days of patient hospitalization and prescribed for at least 2 days. They also gauged for treatment failure (mechanical ventilation initiation or intensive care unit transfer), in-hospital mortality, readmission for asthma within 30 days of discharge, hospital costs, and antibiotic diarrhea.

Of the 22,043 observed patients, 10,162 (46.1%) received antibiotics. Treated patients were an average of 50.5 years old, mostly white (49.6%), and were more likely to smoke than the non-treated population (7.6% versus 5.5%), and suffer from comorbidities.

On average, patients treated with antibiotics stayed a full day longer at the hospital than the non-treated population (4.4 versus 3.4; P < 0.0001), despite similar treatment failure rates (5.56% versus 5.64%).

When considered for propensity matched analysis, antibiotic treatment remained associated with longer hospitalizations (RR: 1.27; 95% CI; 1.25 — 1.29), greater hospitalization costs ($6427 versus $5387), and greater risk for antibiotic-related diarrhea (OR: 1.55; 95% CI; 1.16 – 2.08). However, it was not associated with any increased risk of treatment failure (OR: 1.02; 95% CI; 0.88 – 1.17).

Researchers concluded the results strengthened the evidence showing antibiotics should not be routinely prescribed in the case of adult patients hospitalized with asthma. Stefan reiterated that all observed patients had also received systemic steroids and bronchodilators — the current asthma exacerbation standard-of-care.

“All hospitals should assess their practice in caring for patients hospitalized with asthma and increase their antibiotic stewardship,” Stefan said.

The team is currently planning a qualitative study to understand why physicians continue to administer antibiotics to patients with asthma.

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