A Systematic Review And Meta-analysis On Efficacy Of Azithromycin Adjuvant Therapy For Bronchiolitis

Background: Bronchiolitis is a common lower respiratory infectious disease in children.It has become a widely-concerned public health issue,for its high morbidity and associated economic burden.Nowadays,therapy for bronchiolitis still mainly depends on supportive treatments.Therefore,it is of vital significance for us to effectively remit airway spasm,airway inflammation and hyperresponsiveness,as well as reducing the risk of recurrent wheezing and development of Asthma.Azithromycin,for its anti-inflammatory effect,has been used in chronic inflammation lung diseases.Objective: To evaluate the efficacy on Azithromycin adjuvant therapy for Bronchiolitis and provide evidence for its clinical use.Methods: Literature searching was performed from the establishment of databases(PubMed,Medline,Embase,Cochrane Library,CNKI,Wan Fang Periodical Database and VIP Database)up to March 16 th,2018.Randomised clinical trials were included.Quality assessment and statisticsextraction were performed.We used RevMan 5.3 to conduct the statistical analysis.Results: 14 randomised clinical trials were included,consisting of 5high-quality studies and 9 low-quality studies.The main outcomes are length of hospitalization,length of oxygen support,wheezing reducing time and coughing reducing time,and the secondary outcomes are levels of IL-8,levels of Serum cysteinyl leukotrienes,analysis of the bacterial colonization in airway.Azithromycin can't reduce the length of hospitalization(P=0.08)and oxygen support(P=0.10),while relatively reducing the time of wheezing(P=0.007)and coughing(P < 0.00001).Azithromycin can notably decrease the level of IL-8 in nasopharyn inspiration and level of CysLTs in serum.Analysis of bacterial colonization reveals that Azithromycin can significantly reduce the detection rates of Streptococcus pneumoniae(P=0.0006),Haemophilus(P=0.0002)and M.catarrhalis(P<0.00001).Conclusion: Azithromycin adjuvent therapy for bronchiolitis can reduce the time of wheezing and coughing to some degree,but with no benefit for the length of hospitalization and oxygen support.In addition,Azithromycin can effectively reduce the detection rates of Streptococcus pneumoniae,Haemophilus and M.catarrhalis.There remains controvesy on the efficacy of Azithromycin therapy for lowing risk of recurrent wheezing and development of Asthma.Because of limited number and quality of studies,more multicenter high-qualified large-sampled studies are required.