Antibiotics for nonspecific upper respiratory tract infections and exacerbation risk in children with asthma

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Background: While the gut microbiome plays an important role in asthma, it is unclear if interventions that cause gut dysbiosis, like antibiotics, will increase exacerbation risk in children with asthma. Objectives: To assess if treating a nonspecific upper respiratory tract infection (NURTI) with broad-spectrum or narrow-spectrum antibiotics vs. no antibiotics increases 6-month exacerbation risk in children with asthma. Methods: We emulated a target trial to inform the decision to treat children with asthma visiting an outpatient physician for a NURTI using Quebec administrative data. Children <18 years old with asthma were eligible for the trial if they did not recently use antibiotics or had an exacerbation at the physician visit. Children were followed from 14 days after the visit for 6 months. Treatment strategies evaluated were: 1) broad-spectrum antibiotics, 2) narrow-spectrum antibiotics, or 3) no treatment, defined with drug claims filled within 3 days of the visit. Exacerbation was defined as any oral corticosteroid, emergency department visit, or hospitalization for asthma. We used inverse probability weighting to emulate randomization and estimated marginal HRs of exacerbation for antibiotic treatment strategies vs. no treatment with marginal structural Cox models. Results: Of the 24437 included person-trials, 3688 (15.1%) and 2613 (10.7%) were treated with broad-spectrum and narrow-spectrum antibiotics, respectively. Broad-spectrum antibiotics (HR 1.15 95%CI 1.00,1.34), but not narrow spectrum (HR 1.08; 0.93,1.31), vs. no antibiotics increased exacerbation risk. Conclusion: Broad-spectrum antibiotics increased short-term exacerbation risk in children with asthma.

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