000			03547nam a2200337 4500
001			ESSALUD
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040			_aBMG
041			_aeng
100			_aDenninghoff, Kurt R. _eAutor _954246
245			_aAzithromycin for preschoolers with wheezing in the emergency department
300			_apáginas: 753-764
520			_aBackground: Wheezing illnesses are a leading cause of hospitalization for preschool-age children and are frequently treated with antibiotics. Observational studies have shown more frequent isolation of three pathogenic bacteria (Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae) from nasopharyngeal samples from children with recurrent episodes of wheezing than from those without such illnesses. Methods: In this multicenter trial, we randomly assigned patients 18 to 59 months of age who presented to an emergency department with a moderate-to-severe episode of wheezing to receive azithromycin once daily at a dose of 12 mg per kilogram of body weight or matching placebo for 5 days. The primary outcome was the sum of scores on the Asthma Flare-up Diary for Young Children (ADYC) over 5 days. Primary-outcome scores could range from 5 to 35, with higher scores indicating more severe wheezing-related symptoms. Efficacy was assessed separately in patients who tested positive for pathogenic bacteria (the positive cohort) and in those who tested negative (the negative cohort). Secondary outcomes were length of stay in the emergency department, length of hospital stay, and return emergency department visits or hospitalizations within 72 hours. Bacterial clearance and antimicrobial resistance were measured at follow-up visits 1 to 3 weeks after randomization. Results: Among 840 patients who underwent randomization, 521 tested positive for pathogenic bacteria. The trial was stopped for futility by the data and safety monitoring board after a planned interim analysis. ADYC scores did not differ significantly between the azithromycin and placebo groups in either the positive cohort (median, 9.59 [interquartile range, 7.29 to 12.60] vs. 9.72 [interquartile range, 7.66 to 12.17]; P=0.70) or the negative cohort (median, 9.30 [interquartile range, 6.97 to 11.62] vs. 9.10 [interquartile range, 7.19 to 11.45]; P=0.69). In the positive cohort, bacterial clearance was 58.7% in the azithromycin group and 11.4% in the placebo group. Secondary outcomes appeared to be similar in the two groups for both cohorts, as did the development of bacterial resistance and the incidence of adverse events. Conclusions: Azithromycin did not lead to a greater reduction in the severity of wheezing-related symptoms than placebo in preschool-age children who presented to the emergency department with moderate-to-severe acute wheezing.
650			_aALERGIA _97055
650			_aASMA _99753
650			_aNEUMOLOGÍA _925628
650			_aCUIDADOS INTENSIVOS _95208
650			_aENFERMEDADES INFANTILES _953890
650			_aMEDICINA DE URGENCIAS GENERAL _954078
650			_aPEDIATRÍA GENERAL _954247
700			_aCasper, T. Charles _954248
700			_aZorc, Joseph J. _954249
700			_aRuddy, Richard M. _954250
700			_aSatola, Sarah _954251
700			_aWendt, Wendi-Jo _954252
700			_aMorris, Claudia R. _954253
773	0		_022717 _922650 _dMassachusetts NEJM Group _oNEJM12 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-21 _zsqb
999			_c22852 _d22852