Azithromycin for acute wheezing and bronchiolitis in children younger than six years: A systematic review and meta-analysis.

BACKGROUND

Azithromycin is often prescribed off-label for acute wheezing and bronchiolitis in young children, despite guideline advice against routine antibiotics. We synthesised the randomised evidence and tested whether benefit depends on care setting.

METHODS

We searched four databases and two registries to June 2026 for double-blind, placebo-controlled trials of azithromycin versus placebo in children younger than six years with acute wheezing or bronchiolitis. The acute episode was pooled as the ratio of means and binary outcomes as risk ratios (random-effects models).

RESULTS

Ten trials (2,071 children) were included. In emergency-department and ward patients, azithromycin had no effect on the acute episode (ratio of means 0.99, 95 % CI 0.96-1.04; I2=0 %) and did not reduce hospitalisation or recurrent wheeze. Apparent benefit was confined to intensive-care and home-treated recurrent episodes (between-subgroup p<0.0001).

CONCLUSIONS

Azithromycin does not help children with acute wheezing or bronchiolitis where it is used; routine use is not supported.