Atypical bacteria and acute asthma: Is there a role for antibiotics?

Mohammed Abdel Fattah
5.226 1.101


Atypical bacteria(Mycoplasma pneumoniae and Chlamydophila pneumoniae) are thought to be inflicted in the pathogenesis and precipitation of acute asthma. Past and current infections with these organisms were found more frequently in asthmatics compared to healthy controls. It was suggested that atypical infections could precipitate acute asthma attacks in previously healthy individuals. This has raised the question of whether or not to add antibiotics to the management, especially macrolides. This review highlights the natural history of these organisms and their role in acute asthma of children. The current literature about role of antibiotics in acute asthma is summarized.


Mycoplasma, Chlamydophila, asthma, children

Full Text:




Specjalski K, Jassem E. Chlamydophila pneumoniae, Mycoplasma pneumoniae infections, and asthma control. Allergy Asthma Proc. 2011; 32(2):9-17.

Teig N, Anders A, Schmidt C, Rieger C, Gatermann S. Chlamydophila pneumoniae and Mycoplasma pneumoniae in respiratory specimens of children with chronic lung diseases. Thorax. 2005; 60(11):962-6.

Eaton MD, van Herick W, Meiklejohn G. Studies on the etiology of primary atypical pneumonia : iii. Specific neutralization of the virus by human serum. J Exp Med. 1945; 31; 82(5):329-42. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004; 17(4):697-728.

Annagür A, Kendirli SG, Yilmaz M, Altintas DU, Inal A. Is there any relationship between asthma and asthma attack in children and atypical bacterial infections; Chlamydia pneumoniae, Mycoplasma pneumoniae and Helicobacter pylori. J Trop Pediatr. 2007; 53(5):313-8.

Marrie TJ, Costain N, La Scola B, Patrick W, Forgie S, Xu Z, McNeil SA. The role of atypical pathogens in community-acquired pneumonia. Semin Respir Crit Care Med. 2012; 33(3):244-56. Tsolia MN, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D, Kallergi K, Kafetzis DA, Constantopoulos A, Papadopoulos NG. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis. 2004; 1; 39(5):681-6.

Principi N, Esposito S, Blasi F, Allegra L; Mowgli study group. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections. Clin Infect Dis. 2001; 32(9):1281-9.

Samransamruajkit R, Jitchaiwat S, Wachirapaes W, Deerojanawong J, Sritippayawan S, Prapphal N. Prevalence of Mycoplasma and Chlamydia pneumonia in severe community-acquired pneumonia among hospitalized children in Thailand. Jpn J Infect Dis. 2008 Jan; 61(1):36-9.

Chu HW, Honour JM, Rawlinson CA, Harbeck RJ, Martin RJ. Effects of respiratory Mycoplasma pneumoniae infection on allergen-induced bronchial hyperresponsiveness and lung inflammation in mice. Infect Immun. 2003; 71(3):1520-6.

Patel KK, Vicencio AG, Du Z, Tsirilakis K, Salva PS, Webley WC. Infectious Chlamydia pneumoniae is associated with elevated interleukin-8 and airway neutrophilia in children with refractory asthma. Pediatr Infect Dis J. 2010; 29(12):1093-8.

Janahi IA, Abdulwahab A, Elshafie Sittana S, Bush A. Rapidly progressive lung disease in a patient with cystic fibrosis on long-term azithromycin: possible role of Mycoplasma infection. J Cyst Fibros. 2005; 4(1):71-3.

Emre U, Bernius M, Roblin PM, Gaerlan PF, Summersgill JT, Steiner P, Schachter J, Hammerschlag MR. Chlamydia pneumoniae infection in patients with cystic fibrosis. Clin Infect Dis. 1996; 22(5):819-23.

Esposito S, Blasi F, Arosio C, Fioravanti L, Fagetti L, Droghetti R, Tarsia P, Allegra L, Principi N. Importance of acute Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with wheezing. Eur Respir J. 2000; 16(6):1142-6.

Wood PR, Hill VL, Burks ML, Peters JI, Singh H, Kannan TR, Vale S, Cagle MP,Principe MF, Baseman JB, Brooks EG. Mycoplasma pneumoniae in children with acute and refractory asthma. Ann Allergy Asthma Immunol. 2013; 110(5):328-334.e1.

Ou CY, Tseng YF, Chiou YH, Nong BR, Huang YF, Hsieh KS. The role of Mycoplasma pneumoniae in acute exacerbation of asthma in children. Acta Paediatr Taiwan. 2008;49(1):14-8.

Hanhan U, Orlowski J, Fiallos M. Association of Mycoplasma pneumoniae infections with status asthmaticus. Open Respir Med J. 2008; 2:35-8.

Krishnan M, Kannan TR, Baseman JB. Mycoplasma pneumoniae CARDS toxin is internalized via clathrin-mediated endocytosis. PLoS One. 2013; 7; 8(5):e62706.

Medina JL, Coalson JJ, Brooks EG, Winter VT, Chaparro A, Principe MF, Kannan TR, Baseman JB, Dube PH. Mycoplasma pneumoniae CARDS toxin induces pulmonary eosinophilic and lymphocytic inflammation. Am J Respir Cell Mol Biol. 2012; 46(6):815-22.

Tamari M, Harada M, Hirota T, Nakamura Y. Host molecular defense mechanisms against Chlamydophila pneumoniae and genetic studies of immune-response-related genes in asthma. Recent Pat Inflamm Allergy Drug Discov. 2009; 3(1):17-25.

Szczepanik A, Kozioł-Montewka M, Tuszkiewicz-Misztal E, Niedzielska G, Górnicka G, Niedźwiadek J, Niedzielski A. Evaluation of the association between atypical bacteria infections and respiratory tract diseases with emphasis on bronchial asthma exacerbations in children. Ann Univ Mariae Curie Sklodowska Med. 2004; 59(1):105-11.

Maffey AF, Barrero PR, Venialgo C, Fernández F, Fuse VA, Saia M, Villalba A, Fermepin MR, Teper AM, Mistchenko AS. Viruses and atypical bacteria associated with asthma exacerbations in hospitalized children. Pediatr Pulmonol. 2010; 45(6):619-25.

Sato S, Kawashima H, Kashiwagi Y, Ushio N, Nagai M, Takekuma K, Hoshika A. Prevalence of Chlamydia-pneumoniae-specific immunoglobulin M antibody and acute exacerbations of asthma in childhood. Arerugi. 2007; 56(11):1378-83.

Graham V, Lasserson T, Rowe BH. Antibiotics for acute asthma. Cochrane Database Syst Rev. 2001 ;(3):CD002741.

Fonseca-Aten M, Okada PJ, Bowlware KL, Chavez-Bueno S, Mejias A, Rios AM, Katz K, Olsen K, Ng S, Jafri HS, McCracken GH, Ramilo O, Hardy RD. Effect of clarithromycin on cytokines and chemokines in children with an acute exacerbation of recurrent wheezing: a double-blind, randomized, placebo-controlled trial. Ann Allergy Asthma Immunol. 2006; 97(4):457-63.

Koutsoubari I, Papaevangelou V, Konstantinou GN, Makrinioti H, Xepapadaki P, Kafetzis D, Papadopoulos NG. Effect of clarithromycin on acute asthma exacerbations in children: an open randomized study. Pediatr Allergy Immunol. 2012; 23(4):385-90.

Johnston SL, Blasi F, Black PN, Martin RJ, Farrell DJ, Nieman RB; TELICAST Investigators. The effect of telithromycin in acute exacerbations of asthma. N Engl J Med. 2006 Apr 13; 354(15):1589-600.

Brusselle GG, Vanderstichele C, Jordens P, Deman R, Slabbynck H, Ringoet V, Verleden G, Demedts IK, Verhamme K, Delporte A, Demeyere B, Claeys G, Boelens J, Padalko E, Verschakelen J, Van Maele G, Deschepper E, Joos GF. Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicenter randomized double-blind placebocontrolled trial. Thorax. 2013; 68(4):322-9.

Bébéar C, Raherison C, Nacka F, de Barbeyrac B, Pereyre S, Renaudin H, Girodet PO, Marquant F, Desjardins S, Chêne G, Fayon M. Comparison of Mycoplasma pneumoniae Infections in asthmatic children versus asthmatic adults. Pediatr Infect Dis J. 2014; 33(3):e71-5.

Tang J, Long W, Yan L, Zhang Y, Xie J, Lu G, Yang C. Procalcitonin guided antibiotic therapy of acute exacerbations of asthma: a randomized controlled trial. BMC Infect Dis. 2013; 17; 13:5