Azithromycin lowers rate of infectious exacerbations in bronchiectasis patients

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1. In non-cystic fibrosis bronchiectasis patients, the azithromycin treated group had fewer rates of exacerbations vs. placebo group. 

2. The azithromycin treated group had higher rates of gastrointestinal (GI) adverse effects and macrolide resistance. 

In non-cystic fibrosis bronchiectasis patients, treatment with azithromycin lowered rates of infectious exacerbations, increased lung function and QOL (Quality of Life) measurements vs. the placebo group. The conclusions are in line with previous studies showing reduction in exacerbation following macrolide treatment. The increased macrolide resistance observed with azithromycin therapy is also in concordance with previous cystic fibrosis studies reporting high rates of resistance but without subsequent effect on pulmonary function. The strength of this study lies in its randomized controlled design, as well as its evaluation of azithromycin maintenance treatment over the course of a full year, which excludes seasonal effects on exacerbations. Nonetheless, further studies should examine consequences of increased macrolide resistance in these already infection-prone patients.

Click to read the study, published today in JAMA

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1. In non-cystic fibrosis bronchiectasis patients, the azithromycin treated group had fewer rates of exacerbations vs. placebo group. 

2. The azithromycin treated group had higher rates of gastrointestinal (GI) adverse effects and macrolide resistance.

This [multicenter, double-blind, placebo-controlled, parallel-group] study: This study included patients with non-CF bronchiectasis from 14 hospitals in the Netherlands from April 2008 to September 2010. Patients were randomized to receive oral azithromycin or placebo for 52 weeks. The primary outcome was number of infectious exacerbations with 80% of placebo group having at least 1 exacerbation while 46.5% for azithromycin group had at least one exacerbation. Absolute risk reduction for the azithromycin group was 33.5% with the number of patients needed to treat being 3.0. Secondary outcomes included lung function (FEV1 improved by 1.03 per 3 months for azithromycin group) sputum bacteriology (53/60 or 88% macrolide resistant in azithromycin group vs. 29/112 or 26% in placebo group), inflammatory markers (no significant changes), and adverse effects (higher rates of diarrhea and abdominal pain in azithromycin group).

In sum: In non-cystic fibrosis bronchiectasis patients, treatment with azithromycin lowered rates of infectious exacerbations, increased lung function and QOL (Quality of Life) measurements vs. the placebo group. The conclusions are in line with previous studies showing reduction in exacerbation following macrolide treatment. The increased macrolide resistance observed with azithromycin therapy is also in concordance with previous cystic fibrosis studies reporting high rates of resistance but without subsequent effect on pulmonary function. The strength of this study lies in its randomized controlled design, as well as its evaluation of azithromycin maintenance treatment over the course of a full year, which excludes seasonal effects on exacerbations. Nonetheless, further studies should examine consequences of increased macrolide resistance in these already infection-prone patients.

Click to read the study in JAMA

By Elizabeth Park and Rif Rahman

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