Treating an asthma attack often uses antibiotics. Asthma is a chronic respiratory disorder characterized by wheezing, coughing, shortness of breath (chest tightness), and shortness of breath. Asthma symptoms are generally intermittent and can worsen over a short period (asthma attacks/exacerbations). Asthma attacks can be very severe and require hospitalization and can even lead to death.

Should Antibiotics be Given in Treating an Asthma Attack?

Asthma attacks can indeed be triggered by infection, both viral and bacterial. However, most of the triggers for asthma attacks are multifactorial, with many cases having complications due to viral infections of the upper respiratory tract. Often antibiotics are included in the treatment regimen for asthma attacks, even though bacterial infections trigger only a small proportion of asthma attacks. Most of the infections that trigger asthma attacks are viral infections (such as respiratory syncytial virus [RSV] infections, adenovirus, parainfluenza virus, and influenza virus) and chronic infections (such as mycoplasma and chlamydial infections).

Most guidelines for the management of asthma attacks recommend that antibiotics only be given if there are signs and symptoms, or the results of investigations supporting a bacterial infection as a trigger for asthma attacks.

Use of Antibiotics in Treating Asthma Attack 

Antibiotics are a class of drugs with antimicrobial properties and are used to treat or prevent bacterial infections. Some macrolide class antibiotics (e.g., azithromycin) and ketolide have anti-inflammatory properties. They may benefit patients with asthma. Apart from anti-inflammatory properties, azithromycin is thought to have antiviral properties as well. However, macrolides are still not recommended to treat asthma attacks if there are no obvious signs and symptoms of a bacterial infection.

Normansell et al. (2018) conducted a meta-analysis and found that administering antibiotics for asthma attack might better relieve asthma symptoms than standard treatment or placebo. However, these improvements were not consistent across all studies included in the meta-analysis, and most of the subjects were patients attending the emergency department. Hence, the results of this meta-analysis are difficult to generalize to the general asthma patient population.

Antibiotics work through the bactericidal and bacteriostatic mechanisms to rid bacterial infections. If a bacterial infection is a trigger for asthma attacks, then giving the right antibiotics will help relieve symptoms more quickly. However, if its use is not appropriate or as indicated, then this can cause problems for patients, such as antibiotic resistance and the risk of drug side effects.

Another reason for administering antibiotics in asthma attacks is due to misdiagnosis, especially in children. Children with asthma generally visit the doctor more often with symptoms that tend to worsen over time. The symptoms that appear are often accompanied by bronchiolitis symptoms, atypical pneumonia, and other respiratory infections. Because of these symptoms, they often receive antibiotics, although the greatest etiology is viral. Gedik et al. (2014) found that proper diagnosis and handling of asthma decreased antibiotic use frequency and asthma attacks in children.

A 2015 observational study of patients with asthma and chronic obstructive pulmonary disease (COPD) found that patients with comorbid asthma and COPD received more antibiotics than patients with asthma alone. Abnormal chest examination increased CRP, and decreased oxygen saturation were predictors for prescribing antibiotics in their study.

The antibiotic that is often added to standard asthma therapy regimens is the macrolide azithromycin. However, a randomized clinical trial (RCT) found no significant clinical benefit of adding azithromycin to a standard asthma regimen.

The administration of antibiotics in treating asthma attacks is only supported by weak recent evidence. Administration of antibiotics in treating asthma attacks should be limited to cases of asthma attacks that show signs, symptoms, or investigations that support bacterial infection as the trigger. Most infections that trigger asthma attacks are viral infections, so you don't need antibiotics.

The administration of antibiotics in treating asthma attacks can lead to antibiotic resistance. Also, the irrational use of antibiotics will put patients at risk of experiencing the side effects of unnecessary drugs.