Abstract：
OBJECTIVE: To characterize the prescribing trends and clinical outcomes related to azithromycin (AZI) among children hospitalized for critical asthma (CA).
METHODS: We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3 to 17 years of age hospitalized in a PICU for CA from January 2011 to December 2022. We excluded for alternative indications for AZI (eg, atypical pneumonia, B. pertussis infection, acute otitis media, acute sinusitis, pharyngitis/tonsillitis, and urethritis). The primary outcome was AZI prescribing rate by hospital and calendar year (trends assessed by Joinpoint regression). Cohorts with and without AZI exposure were further characterized by demographics, CA treatments, and inpatient outcomes using descriptive and comparative (ie, χ2 and Wilcoxon rank tests) statistics.
RESULTS: Of the 47 797 children studied, 9901 (20.7%) were prescribed AZI with a downward annual trend noted from 34.7% in 2011% to 12.4% in 2022 (-1.7% per year, R2 = 0.91). Median institutional AZI prescribing rate was 19.2% (interquartile range [IQR] 11.7%-28%; total range 5.6%-60%). Compared with children not prescribed AZI, those prescribed AZI were older (median 8.3 [IQR 5.7-11.6] vs 7.3 [4.9-10.8] years, P < .001) and experienced a more severe clinical trajectory with greater rates of bilevel positive airway pressure ventilation (19.7% vs 12.6%, P < .001), invasive ventilation (22.1% vs 13.5%, P < .001), extracorporeal life support (0.8% vs 0.1%, P < .001), and median length of stay (4 [IQR 3-6] vs 3 [IQR 2-4] days, P < .001).
CONCLUSIONS: Between 2011 and 2022, 20.7% of children hospitalized for CA were prescribed AZI notwithstanding the absence of trial-derived efficacy or safety data for this indication and population.
METHODS: We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3 to 17 years of age hospitalized in a PICU for CA from January 2011 to December 2022. We excluded for alternative indications for AZI (eg, atypical pneumonia, B. pertussis infection, acute otitis media, acute sinusitis, pharyngitis/tonsillitis, and urethritis). The primary outcome was AZI prescribing rate by hospital and calendar year (trends assessed by Joinpoint regression). Cohorts with and without AZI exposure were further characterized by demographics, CA treatments, and inpatient outcomes using descriptive and comparative (ie, χ2 and Wilcoxon rank tests) statistics.
RESULTS: Of the 47 797 children studied, 9901 (20.7%) were prescribed AZI with a downward annual trend noted from 34.7% in 2011% to 12.4% in 2022 (-1.7% per year, R2 = 0.91). Median institutional AZI prescribing rate was 19.2% (interquartile range [IQR] 11.7%-28%; total range 5.6%-60%). Compared with children not prescribed AZI, those prescribed AZI were older (median 8.3 [IQR 5.7-11.6] vs 7.3 [4.9-10.8] years, P < .001) and experienced a more severe clinical trajectory with greater rates of bilevel positive airway pressure ventilation (19.7% vs 12.6%, P < .001), invasive ventilation (22.1% vs 13.5%, P < .001), extracorporeal life support (0.8% vs 0.1%, P < .001), and median length of stay (4 [IQR 3-6] vs 3 [IQR 2-4] days, P < .001).
CONCLUSIONS: Between 2011 and 2022, 20.7% of children hospitalized for CA were prescribed AZI notwithstanding the absence of trial-derived efficacy or safety data for this indication and population.
摘要：
■在重症哮喘（CA）住院的儿童中，描述与阿奇霉素（AZI）相关的处方趋势和临床结局。
■我们执行了一个多中心，2011年1月至2022年12月,采用儿科健康信息系统注册的3~17岁儿童因CA在PICU住院的回顾性队列研究.我们排除了AZI的替代适应症(例如，非典型肺炎，百日咳杆菌感染，急性中耳炎,急性鼻窦炎,咽炎/扁桃体炎，和尿道炎）。主要结果是按医院和日历年的AZI处方率（通过Joinpoint回归评估的趋势）。有和没有AZI暴露的队列进一步通过人口统计学来表征，CA治疗,和使用描述性和比较性的住院结果(即，χ2和Wilcoxon秩检验)统计。
■在研究的47797名儿童中，9901(20.7%)服用AZI，年度趋势从2011年的34.7%下降到2022年的12.4%(每年-1.7%，R2=0.91）。机构AZI处方率中位数为19.2%（四分位数范围[IQR]11.7%-28%；总范围5.6%-60%）。与未开AZI处方的儿童相比，那些开了AZI的人年龄较大（中位数8.3[IQR5.7-11.6]vs7.3[4.9-10.8]年，P<.001），并且经历了更严重的临床轨迹，双水平气道正压通气率更高（19.7％vs12.6％，P<.001),有创通气（22.1%vs13.5%，P<.001),体外生命支持(0.8%对0.1%，P<.001),和中位住院时间(4[IQR3-6]vs3[IQR2-4]天，P<.001)。
■在2011年至2022年之间，尽管缺乏该适应症和人群的试验得出的疗效或安全性数据，但仍有20.7％的因CA住院的儿童被处方为AZI。
■我们执行了一个多中心，2011年1月至2022年12月,采用儿科健康信息系统注册的3~17岁儿童因CA在PICU住院的回顾性队列研究.我们排除了AZI的替代适应症(例如，非典型肺炎，百日咳杆菌感染，急性中耳炎,急性鼻窦炎,咽炎/扁桃体炎，和尿道炎）。主要结果是按医院和日历年的AZI处方率（通过Joinpoint回归评估的趋势）。有和没有AZI暴露的队列进一步通过人口统计学来表征，CA治疗,和使用描述性和比较性的住院结果(即，χ2和Wilcoxon秩检验)统计。
■在研究的47797名儿童中，9901(20.7%)服用AZI，年度趋势从2011年的34.7%下降到2022年的12.4%(每年-1.7%，R2=0.91）。机构AZI处方率中位数为19.2%（四分位数范围[IQR]11.7%-28%；总范围5.6%-60%）。与未开AZI处方的儿童相比，那些开了AZI的人年龄较大（中位数8.3[IQR5.7-11.6]vs7.3[4.9-10.8]年，P<.001），并且经历了更严重的临床轨迹，双水平气道正压通气率更高（19.7％vs12.6％，P<.001),有创通气（22.1%vs13.5%，P<.001),体外生命支持(0.8%对0.1%，P<.001),和中位住院时间(4[IQR3-6]vs3[IQR2-4]天，P<.001)。
■在2011年至2022年之间，尽管缺乏该适应症和人群的试验得出的疗效或安全性数据，但仍有20.7％的因CA住院的儿童被处方为AZI。
