Science Advance: Early Antibiotic Use for Preschool Children with Recurrent Wheezing

Anne Fitzpatrick, PhD, MSCR, APRN, is an Atlanta Clinical & Translational Science Institute (ACTSI) Master of Science in Clinical Research (MSCR) graduate, as well as site director for the ACTSI Pediatrics Clinical Research Unit at Egleston, associate professor of pediatrics, and director of the Asthma Clinical Research Program at Emory University School of Medicine. A certified pediatric nurse practitioner with a broad background in clinical and translational pediatric asthma research, she focuses on the clinical and molecular features of children with asthma. She is currently funded by a variety of NIH grants and serves as the Principal Investigator in the National Heart, Lung, and Blood Institute’s AsthmaNet Clinical Trials Network and Severe Asthma Research Program. Recently, she was published in the Journal of the American Medical Association (JAMA) for her part in a multi-Clinical and Translational Science Award (CTSA) randomized control trial that addresses the use of a common antibiotic for preschool children with recurrent wheezing. ACTSI supported her research through the Pediatric Clinical Research Unit at Egleston for the conduct of the trial.

Respiratory infections (“colds”) are very common in preschool children. Although most children recover easily, some develop wheezing and difficulty breathing warranting emergency care. The ACTSI-supported clinical trial evaluated whether the early administration of the antibiotic azithromycin during a cold prevented wheezing and other lower respiratory symptoms in preschool children age 12-71 months with a history of recurrent wheezing. The study enrolled 607 participants and was conducted at nine academic U.S. medical centers in the National Heart, Lung and Blood Institute’s AsthmaNet network.  

Although equal numbers of respiratory infections were reported in both the azithromycin and the placebo groups, the children who received azithromycin at the earliest signs of a cold had less severe respiratory infections. Because of concerns of antibiotic resistance, azithromycin-resistant germs were also evaluated in a subset of children. Some children who received azithromycin did have azithromycin-resistant germs, but azithromycin-resistant germs were also observed in some children in the placebo group. A larger study is needed to determine whether the difference in azithromycin resistant germs is statistically or clinically meaningful. “Although our study suggests that we can reduce the severity of respiratory illnesses with early azithromycin administration, we still have to be prudent with our antibiotic use” said Fitzpatrick. “Also, it is important to keep in mind that azithromycin does not lengthen the time between infections or prevent them from happening.”

The Emory Master of Science in Clinical Research (MSCR) degree program, from the Laney Graduate School at Emory University, provides didactic and mentored clinical and translational research training. The degree is designed for participants at Emory University and Georgia Tech who hold a doctorate or equivalent degree (such as physicians and PhD-level scientists) or predoctoral trainees enrolled in a dual degree program (MD/MSCR and PhD/MSCR tracks) and have demonstrated a commitment to a career in clinical investigation.

ACTSI’s Pediatric Clinical Research Unit at Egleston offers inpatient and outpatient space and provides valuable research implementation services for clinical researchers, including laboratory and nursing services. The ACTSI is a city-wide partnership between Emory, Morehouse School of Medicine, and Georgia Tech and is one of a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences as one of the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.