Azithromycin for Preschoolers with Wheezing in the Emergency Department

Kurt R. Denninghoff; T Charles Casper; Joseph J. Zorc; Richard M. Ruddy; S Satola; Wendi-Jo Wendt; Claudia R. Morris; Melissa M. Tavarez; Matthew J. Lipshaw; Maria Y. Kwok; Jo-Ann Nesiama; Kyle A. Nelson; Michael Webb; Fernando D. Martínez

doi:10.1056/nejmoa2516505

May 18, 2026New England Journal of Medicine

Azithromycin for Preschoolers with Wheezing in the Emergency Department

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Key Points

To determine whether oral azithromycin reduces wheezing symptom severity compared to placebo in preschool-aged children presenting to the emergency department with acute moderate-to-severe wheezing.
Study (AZ-SWED, NCT04669288) assigning 840 patients aged 18 to 59 months with moderate-to-severe wheezing to azithromycin (12 mg/kg daily) or matching placebo for 5 days.
Outcomes were evaluated separately in children testing positive or negative for nasopharyngeal pathogenic bacteria.
The primary outcome was the 5-day sum of Asthma Flare-up Diary for Young Children (ADYC) scores (range 5 to 35); the trial was stopped early for futility after a planned interim analysis.
ADYC scores did not differ significantly between azithromycin and placebo in either the bacteria-positive cohort (median 9.59 [IQR 7.29–12.60] vs. 9.72 [IQR 7.66–12.17]; P = 0.70) or the bacteria-negative cohort (median 9.30 [IQR 6.97–11.62] vs. 9.10 [IQR 7.19–11.45]; P = 0.69).
In the bacteria-positive cohort, bacterial clearance was 58.7% with azithromycin versus 11.4% with placebo at 1 to 3 weeks follow-up.
Emergency department stay lengths, hospital stay lengths, 72-hour return visits or hospitalizations, bacterial resistance, and adverse events showed no notable differences between groups.

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Implication

Reveals azithromycin does not reduce wheezing severity in preschool-aged emergency department patients, suggesting routine antibiotic use provides no symptom benefit.

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Denninghoff et al. (2026) studied this question.

synapsesocial.com/papers/6a0c2b23aff5732a0d730705 https://doi.org/10.1056/nejmoa2516505

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Azithromycin for Preschoolers with Wheezing in the Emergency Department

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Azithromycin for Preschoolers with Wheezing in the Emergency Department

Key Points

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Implication

Discussion

Cite This Study

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