TITLE

Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial

AUTHOR(S)
Wolter, J.; Seeney, S.; Bell, S.; Bowler, S.; Masel, P.; McCormack, J.
PUB. DATE
March 2002
SOURCE
Thorax;Mar2002, Vol. 57 Issue 3, p212
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Relentless chronic pulmonary inflammation is the major contributor to morbidity and mortality in patients with cystic fibrosis (CF). While immunomodulating therapies such as prednisolone and ibuprofen may be beneficial, their use is limited by side effects. Macrolides have immunomodulatory properties and long term use dramatically improves prognosis in diffuse panbronchiolitis, a condition with features in common with the lung disease of CF. Methods: To determine if azithromycin (AZM) improves clinical parameters and reduces inflammation in patients with CF, a 3 month prospective randomised double blind, placebo controlled study of AZM (250 mg/day) was undertaken in adults with CF. Monthly assessment included lung function, weight, and quality of life (QOL). Blood and sputum collection assessed systemic inflammation and changes in bacterial flora. Respiratory exacerbations were treated according to the policy of the CF Unit. Results: Sixty patients were recruited (29 men) of mean (SD) age 27.9 (6.5) years and initial forced expiratory volume in 1 second (FEV1) 56.6 (22.3)% predicted. FEV1% and forced vital capacity (FVC)% predicted were maintained in the AZM group while in the placebo group there was a mean (SE) decline of -3.62 (1 .78)% (p=0.047) and -5.73 (1 .66)% (p=0.001), respectively. Fewer courses of intravenous antibiotics were used in patients on AZM (0.37 v 1 .13, p=0.016). Median C reactive protein (CRP) levels declined in the AZM group from 10 to 5.4 mg/ml but remained constant in the placebo group (p<0.001). QOL improved over time in patients on AZM and remained unchanged in those on placebo (p=0.035). Conclusion: AZM in adults with CF significantly improved QOL, reduced CRP levels and the number of respiratory exacerbations, and reduced the rate of decline in lung function. Long term AZM may have a significant impact on morbidity and mortality in patients with CF. Further studies are required to define frequency of dosing and duration of benefit.
ACCESSION #
12915249

 

Related Articles

  • Effectiveness and safety of macrolides in cystic fibrosis patients: a meta-analysis and systematic review. Yun Cai; Dong Chai; Rui Wang; Nan Bai; Bei-Bei Liang; Youning Liu // Journal of Antimicrobial Chemotherapy (JAC);May2011, Vol. 66 Issue 5, p968 

    Objectives To evaluate the efficacy and safety of macrolides in cystic fibrosis (CF). Methods Randomized controlled trials (RCTs) of macrolides for the treatment of CF published in PubMed, the Cochrane Library and Embase were searched. Application of inclusion and exclusion criteria, data...

  • Is Azithromycin the First-Choice Macrolide for Treatment of Community-Acquired Pneumonia? Sánchez, Francesca // Clinical Infectious Diseases;7/1/2004, Vol. 39 Issue 1, p145 

    This article presents response of the author to an article about the treatment of community-acquired pneumonia (CAP) with two macrolides, clarithromycin and azithromycin. The severity of CAP in patients who have received a diagnosis of CAP in the author's hospital has been scored using the...

  • Characterization of macrolide resistance genes in Haemophilus influenzae isolated from children with cystic fibrosis. Roberts, Marilyn C.; Soge, Olusegun O.; No, David B. // Journal of Antimicrobial Chemotherapy (JAC);Jan2011, Vol. 66 Issue 1, p100 

    Objectives To determine the mechanism(s) of macrolide resistance in Haemophilus influenzae isolated from cystic fibrosis (CF) patients participating in a randomized placebo-controlled trial of azithromycin. Methods Macrolide susceptibility, mutations and carriage of the macrolide resistance...

  • Long term effects of azithromycin in patients with cystic fibrosis: a double blind, placebo controlled trial. Clement, A.; Tamalet, A.; Leroux, E.; Ravilly, S.; Fauroux, B.; Jais, J.-P. // Thorax;Oct2006, Vol. 61 Issue 10, p895 

    Background: Macrolides display immunomodulatory effects that may be beneficial in chronic inflammatory pulmonary diseases. The aim of the study was to document whether long term use of azithromycin may be associated with respiratory benefits in young patients with cystic fibrosis. Methods: A...

  • Macrolides in cystic fibrosis. Bell, SC; Senini, SL; McCormack, JG // Chronic Respiratory Disease;2005, Vol. 2 Issue 2, p85 

    Macrolide antibiotics have been licensed since the 1950s and have an important role in the treatment of a diverse range of infectious diseases. Macrolide antibiotics have antibacterial activity against grampositive bacteria, some gram-negative bacteria and intracellular pathogens. The spectrum...

  • Outcome of Burkholderia cepacia colonisation in an adult cystic fibrosis centre. Ledson, M. J.; Gallagher, M. J.; Jackson, M.; Hart, C. A.; Walshaw, M. J. // Thorax;Feb2002, Vol. 57 Issue 2, p142 

    Background: Colonisation with Burkholderia cepacia is a poor prognostic indicator in subjects with cystic fibrosis (CF), but outcome prediction is impossible since patients are colonised by different strains with differing pathogenicity. The clinical course of a Jorge cohort of CF patients...

  • Consider adding this drug to fight COPD that's severe. Hobbs, Keia; Brown, Dionna; Mounsey, Anne // Journal of Family Practice;Jul2012, Vol. 61 Issue 7, p414 

    Daily use of azithromycin, in conjunction with the usual COPD regimen, has been found to reduce acute exacerbations in patients with moderate to severe disease.

  • Two Regimens of Azithromycin Prophylaxis against Community-Acquired Respiratory and Skin/Soft-Tissue Infections among Military Trainees. Guchev, Igor A.; Gray, Gregory C.; Klochkov, Oleg I. // Clinical Infectious Diseases;4/15/2004, Vol. 38 Issue 8, p1095 

    Epidemics of community-acquired pneumonia (CAP) are a frequent cause of morbidity among Russian military trainees. We evaluated azithromycin prophylaxis against CAP. In 2001-2002, incoming military trainees were randomized to 1 of 3 trial arms by training group: azithromycin, 500 mg per week for...

  • Azithromycin Extended Release: A Review of its Use in the Treatment of Acute Bacterial Sinusitis and Community-Acquired Pneumonia in the US. Swainston, Tracy; Kean, Susan J. // Drugs;2007, Vol. 67 Issue 5, p773 

    Azithromycin is a macrolide antibacterial agent. The novel microspheres oral extended-release formulation (Zmaxâ„¢) is the first antibacterial drug approved in the US for administration as a single dose in adult patients with mild to moderate acute bacterial sinusitis (ABS) or...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics