Azithromycin for acute wheezing and bronchiolitis in children younger than six years: A systematic review and meta-analysis
In brief
Azithromycin leaves acute wheezing unchanged in emergency and ward patients
Across 10 placebo-controlled trials involving 2,071 children younger than six, azithromycin did not improve the acute episode or reduce hospitalisation or recurrent wheezing in emergency-department and ward patients. Apparent benefit was limited to intensive-care and home-treated recurrent episodes, so routine use is not supported; whether those subgroup findings reflect a true difference remains unclear.
- Journal
- Paediatric respiratory reviews (Q1)
- Published
- 30 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Douglas Amaral da Silva Menegazzo Miotto, Isabela Ovídio Ramos, Caroline Molina Grassi
- PMID
- 42881103
- DOI
- 10.1016/j.prrv.2026.09.002
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 16 October 2026): Azithromycin does not help children with acute wheezing or bronchiolitis
Abstract
BACKGROUND: Azithromycin is often prescribed off-label for acute wheezing and bronchiolitis in young children, despite guideline advice against routine antibiotics. We synthesised the randomised evidence and tested whether benefit depends on care setting. METHODS: We searched four databases and two registries to June 2026 for double-blind, placebo-controlled trials of azithromycin versus placebo in children younger than six years with acute wheezing or bronchiolitis. The acute episode was pooled as the ratio of means and binary outcomes as risk ratios (random-effects models). RESULTS: Ten trials (2,071 children) were included. In emergency-department and ward patients, azithromycin had no effect on the acute episode (ratio of means 0.99, 95 % CI 0.96-1.04; I2=0 %) and did not reduce hospitalisation or recurrent wheeze. Apparent benefit was confined to intensive-care and home-treated recurrent episodes (between-subgroup p<0.0001). CONCLUSIONS: Azithromycin does not help children with acute wheezing or bronchiolitis where it is used; routine use is not supported.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.