Should Hospitalized Asthma Patients Receive Antibiotics? Interview with:
Mihaela S Stefan, MD, PhD FACP

Research Scientist, Institute for Healthcare Delivery and Population Science
Associate Professor, UMMS-Baystate
Director of Perioperative Clinic and Medical Consultation Program
Academic Hospitalist
Director Quality Assessment, Division of Healthcare Quality
Springfield MA What is the background for this study? What are the main findings?

Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death.

We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. What should readers take away from your report?

Response: Our findings support the current guidelines that antibiotics are not indicated in patients with asthma; clinicians should treat patients with asthma exacerbation with bronhodilators and steroids and should not deviate from the guidelines because of the severity of the presentation or because the patient has comorbidities or because patients ask for antibiotics. There are more than 400 000 patients with asthma hospitalized yearly and treating 40% of them with antibiotics when they don’t need them increases the risk for antibiotic resistance and antibiotic related side effects. What recommendations do you have for future research as a result of this work? 

Response: We just completed a qualitative study and interviewed clinicians on why they prescribe antibiotics. Our next step is to design, pilot and implement a strategy to reduce antibiotic prescribing in this population. Is there anything else you would like to add? 

Response: Asthma is not a condition that stewards of antibiotic prescribing have it on their list. Institutions need to expand their assessment of inappropriate prescribing of antibiotics to include asthma and target it correctly.

No disclosure.


Stefan MS, Shieh M, Spitzer KA, et al. Association of Antibiotic Treatment With Outcomes in Patients Hospitalized for an Asthma Exacerbation Treated With Systemic Corticosteroids. JAMA Intern Med. Published online January 28, 2019. doi:10.1001/jamainternmed.2018.5394

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Last Updated on February 4, 2019 by Marie Benz MD FAAD