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Antibiotics linked to longer hospital stay for asthma
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Patients hospitalized for asthma who received antibiotic therapy had a significantly longer hospital length of stay and higher hospital costs, according to findings published in JAMA Internal Medicine.
“Current guidelines for the treatment of patients hospitalized for an asthma exacerbation call for objective assessment of lung function, controlled oxygen administration, inhaled short-acting beta2-agonist bronchodilators and systemic corticosteroids, but several studies have documented limited adherence to these guidelines and variation in acute and chronic asthma care,” Mihaela S. Stefan, MD, PhD, research scientist at the Institute for Healthcare Delivery and Population Science and associate professor at the University of Massachusetts Medical School, and colleagues wrote.
Stefan and colleagues conducted a retrospective cohort study to determine the clinical outcomes associated with adding antibiotic therapy to the treatment regimen among patients hospitalized for asthma already treated with corticosteroids between 2015 and 2016 (n = 19,811; median age, 46 years; 72.6% women; 44.3% white).
Participants were exposed to early antibiotic treatment during the first 2 days of hospitalization for a minimum of 2 days. The researchers measured hospital length of stay, hospital costs, antibiotic-related diarrhea and treatment failure defined as initiation of mechanical ventilation, transfer to the ICU after 2 days, in-hospital mortality or readmission for asthma.
Nearly half (44.4%) of participants were prescribed antibiotics. Patients who were prescribed antibiotics were more likely to be older (median age, 48 vs. 45 years), white (48.6% vs 40.9%) and smokers (6.6% vs. 5.3%) than those who were not prescribed antibiotics. Patients treated with antibiotics were also more likely to have more comorbidities, such as congestive heart failure (6.2% vs. 5.8%).
Significantly longer hospital stays were observed among patients treated with antibiotics (median, 4 vs. 3 days). Patients receiving antibiotics had a greater risk for antibiotic-related diarrhea (adjusted OR = 1.6; 95% CI, 1.2-1.9). The rate of treatment failure was similar among both groups (5.4% vs. 5.8%).
The propensity score-matched analysis revealed that adding antibiotic therapy increased the length of hospital stays by 29% (length of stay ratio, 1.29; 95% CI, 1.27-1.31). Receiving antibiotics was also associated with higher cost of hospitalization (median cost, $4,776 vs. $3,641). However, the risk of treatment failure did not differ between the groups (propensity score–matched OR = 0.95; 95% CI, 0.82-1.11).
Results were similar when accounting for multivariable adjustment, propensity score weighting, and instrumental variables.
“Asthma exacerbations are responsible for 440,000 hospitalization each year,” Stefan told Healio Primary Care Today. “We found that 40% of hospitalized patients received antibiotics despite guidelines recommending against their use; that means roughly 176,000 patients receive antibiotics without need. This, of course, increases the risk for antibiotic resistance and antibiotic-related side effects.”
“Our results strengthen the evidence that antibiotics should not be prescribed routinely in patients with an asthma exacerbation,” she added. “Clinicians should make sure that they do not treat asthma and COPD in the same way. There is no evidence for using antibiotics in asthma, but guidelines recommend antibiotics in patients with moderate to severe COPD. Standard of care for asthma remains steroids and bronchodilators.” – by Alaina Tedesco
Disclosures: Stefan reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.