Kids with asthma can have wheezing attacks severe enough to trigger a visit to the ER.
However, a new trial shows that getting antibiotics once they are there won’t help.
In fact, the trial was stopped early after researchers found the antibiotic azithromycin was useless in easing wheeze.
“We can say with a high degree of certainty that children who come to the doctor’s office or the emergency room with a severe wheezing episode should not be given azithromycin or any antibiotic,” said lead researcher Dr. Fernando Martinez. He’s the director of the Asthma and Airway Disease Research Center at the University of Arizona in Tucson.
His team reported its findings May 18 at a meeting of the American Thoracic Society in Orlando, Florida. The study was published simultaneously in The New England Journal of Medicine.
Asthma and related wheezing are the leading reason U.S. kids under 5 are hospitalized, according to information from the researchers. More than 2.2 million children ages 2 to 5 require ER visits for wheeze each year.
It’s long been noted that childhood wheezing episodes are associated with the presence of certain bacteria — Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae — in the throat.
Could fighting these bacterial strains with antibiotics help ease the wheezing?
To find out, Martinez’s team compared outcomes for 840 children admitted to U.S. emergency rooms with wheezing episodes. The children were between 18 months and almost 5 years of age.
In all, 521 of the 840 children tested positive for at least one kind of possibly harmful bacteria, the researchers said.
Kids were randomly selected to receive either the antibiotic azithromycin or a “dummy” placebo pill as part of their treatment in the ER.
No clinical benefit was seen from use of the antibiotic.
Martinez hopes the findings might curb what he believes to be a misguided treatment.
“We’ve been saying for years that antibiotics should not be used in these acute situations because the wheezing is caused by viruses,” he said in a university news release. “But clinicians still use antibiotics at least a quarter of the time in these young children.”
Besides being ineffective, use of the drugs in this context could raise the odds for antibiotic resistance, the researchers noted.
“If you treat these children with antibiotics when they are already sick with a virus, you don’t get any improvement,” said Martinez, who is also professor of pediatrics at the university. “The fact that the children with the pathogenic bacteria didn’t respond to the antibiotic – even if we eradicated the bacteria – challenges the idea that bacteria cause the wheezing. The bacteria are probably there because the children have a susceptibility.”
His team noted that nearly three-quarters of the children in the study were co-infected with the common cold virus. That could explain the real reason for the presence of bacteria: The germs are there because the child’s immune system has already been compromised.
So, the bacteria may not cause wheezing, Martinez theorized.
Instead, “the bacteria are taking advantage of the fact that the child has an inappropriate response to the virus,” he said.
RELATED: How Asthma Research Is Changing for Black Patients
Research shows that Black children are disproportionately affected by asthma, as they experience higher rates of diagnosis, emergency room visits, and asthma-related complications than their white peers. In addition, Black children have a lower likelihood of outgrowing childhood asthma compared to white children. Because wheezing episodes often lead to emergency care, it’s important for families to understand which treatments work — and which don’t.
Antibiotics are meant to treat bacterial infections. However, most asthma–related wheezing episodes are triggered by viruses, allergies, air pollution, or other environmental factors — not bacteria. That’s why antibiotics typically don’t improve symptoms and may expose children to unnecessary side effects, such as diarrhea, nausea, or antibiotic resistance.
There’s no one-size-fits-all approach to managing childhood asthma. Treatment depends on a child’s age, symptoms, asthma severity, and triggers. Healthcare providers may adjust medications over time to find the most effective treatment plan for preventing wheezing long-term.
Long-term asthma control medications can include:
Short-term asthma control can involve inhaled short-acting beta2-agonist (SABA) with monitoring of response.
Having an asthma action plan can also benefit families. An asthma action plan is a personalized, written document provided by your child’s pediatrician or asthma specialist. It lists your child’s specific daily medications, asthma triggers, and a step-by-step traffic-light system (green, yellow, and red zones) detailing how to manage symptoms and when to seek immediate medical attention.
In addition, reducing asthma triggers can help prevent wheezing episodes. Common triggers include tobacco smoke, dust mites, mold, pet dander, pollen, strong fragrances, and air pollution. Identifying and avoiding your child’s triggers can be an important part of long-term asthma control.
Due to longstanding housing and environmental inequities, Black families are more likely to encounter asthma triggers such as poor air quality, mold, pest allergens, and older housing conditions that can worsen asthma symptoms in children.
RELATED: 8 Hidden Asthma Triggers to Address TODAY
If you have to bring your child to the emergency room after a severe asthma episode, here’s what you can ask a provider about better symptom management:
The findings from the study reinforce what experts have said for years: antibiotics aren’t effective for most asthma-related wheezing episodes in children. Instead of requesting antibiotics, parents should focus on proven asthma treatments, trigger management, and regular follow-up care. For Black families, who often face a greater burden from asthma, having an asthma action plan and knowing when to seek care can make a significant difference.
For Black families, who often face a greater burden from asthma, understanding the difference between asthma symptoms and bacterial infections — and having an asthma action plan in place — can help children stay healthier and avoid unnecessary trips to the emergency room.
More information
Find out more about wheezing and asthma at the Allergy & Asthma Network.
SOURCE: University of Arizona, Tucson, news release, May 18, 2026
By subscribing, you consent to receive emails from BlackDoctor.com. You may unsubscribe at any time. Privacy Policy & Terms of Service.
