COPD Episodes Cut With Azithromycin

Posted by: admin on: September 5, 2011

Azithromycin has been found to decrease exacerbations of chronic pulmonary disease. This could be a boon both to the patients and the treating physician. Take a look at the article.


Acute exacerbations of chronic obstructive pulmonary disease (COPD) declined significantly in high-risk patients treated with azithromycin, data from a large, randomized trial showed.

The hazard ratio for acute exacerbations decreased by 27% during a year of follow-up. The time to first exacerbation of COPD increased by more than 50% with azithromycin compared with placebo.

The azithromycin group also had more than a fourfold greater improvement in self-reported lung function compared with placebo, and 20% more azithromycin patients met criteria for clinically important improvement, investigators reported in the Aug. 25 issue of the New England Journal of Medicine. The primary endpoint was the time to first acute exacerbation of COPD. Secondary outcomes included quality of life, nasopharyngeal colonization of selected respiratory pathogens, and medication adherence.

Additionally, study participants were assessed by means of the St. George’s Respiratory Questionnaire and the SF-36 health survey at baseline, after six months, and at the end of the study.
Investigators randomized 1,142 patients, and about 90% of study participants completed the trial. Patients were given a dose of 250 mg daily of azithromycin (570 participants) or placebo (572 participants).

Results showed that patients in the azithromycin arm had a median time to first acute exacerbation of 266 days versus 174 days in the placebo group (P<0.001). The difference translated into a hazard ratio of 0.73 in favor of azithromycin (P<0.001).

The advantage for azithromycin persisted after adjustment for sex, baseline lung function, patient age, and treatment center.
From an efficacy perspective, the trial results “tip the scales toward the benefits of azithromycin improvement,” Nikolaos Safaris, MD, PhD, of the University of Crete in Greece, wrote in an accompanying editorial.

“However, if azithromycin is going to be used in patients who are known to have frequent exacerbations of COPD, then the local antibiotic resistance patterns should be closely monitored. It also makes sense to ask whether, in such patients, subsequent exacerbations should be treated empirically with a different class of antibiotics.


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