The adverse effects of
azithromycin on the treatment of patients with chronic
lung diseases (CLD) were evaluated in the present study. MEDLINE and other databases were searched for relevant articles published until August 2013. Randomized controlled trials that enrolled patients with chronic
lung diseases who received long-term
azithromycin treatment were selected, and data on microbiological studies and
azithromycin-related adverse events were abstracted from articles and analyzed. Six studies were included in the meta-analysis. The risk of bacterial resistance in patients receiving long-term
azithromycin treatment was increased 2.7-fold (risk ratio [RR], 2.69 [95% confidence interval {95% CI}, 1.249, 5.211]) compared with the risk in patients receiving placebo treatment. On the other hand, the risk of bacterial colonization decreased in patients receiving
azithromycin treatment (RR, 0.551 [95% CI, 0.460, 0.658]). Patients receiving long-term
azithromycin therapy were at risk of increased impairment of hearing (RR, 1.168 [95% CI, 1.030, 1.325]). This analysis provides evidence supporting the idea that bacterial resistance can develop with long-term
azithromycin treatment. Besides the increasingly recognized anti-inflammatory role of
azithromycin used in treating chronic
lung diseases, we should be aware of the potential for adverse events with its long-term use.