Long-term, low-dose erythromycin in bronchiectasis subjects with frequent infective exacerbations.

Abstract

BACKGROUND:

Macrolide antibiotics are increasingly prescribed for subjects with non-cystic fibrosis (CF) bronchiectasis, an empiric extension of their proven efficacy in CF. Widespread, injudicious use of long-acting macrolides, particularly azithromycin, risks significantly increasing population antimicrobial resistance.

METHODS:

In an attempt to power a definitive randomised-controlled trial (RCT), an uncontrolled evaluation of the impact of long-term, low-dose oral erythromycin therapy upon pulmonary exacerbation frequency in non-CF bronchiectasis subjects was performed. Adult bronchiectasis subjects with at least 2 infective exacerbations in the preceding 12 months were followed for 12 months following commencement of prophylactic oral erythromycin 250 mgs daily. The co-primary outcome measures, comparing the 12 month erythromycin and pre-erythomycin periods, were numbers of infective exacerbations and days of antibiotic therapy for infective exacerbations.

RESULTS:

In the 24 evaluable subjects completing a minimum of 12 months of therapy, erythromycin was associated with halving of both the median (range) annual number of infective exacerbations (2 (0-8) vs. 4 (2-11), 95% CI 1.5 to 3.5, p < 0.0001) and annual days of antibiotic use (21 (0-78) vs. 44 (15-138), 95% CI 18 to 40, p < 0.0001) compared with the preceding 12 month period.

CONCLUSIONS:

Low-dose erythromycin may have a robust effect upon exacerbation frequency in non-CF bronchiectasis subjects with frequent exacerbations and this warrants proceeding to a definitive intervention study. These data have enabled powering of an RCT of long-term, low-dose erythromycin, which is now underway and also incorporates bronchoscopic evaluation for pathophysiologic data.

• Authors: D J Serisier, M L Martin
• Journal: Respiratory medicine (Respir Med) Vol. 105 Issue 6 Pg. 946-9 (Jun 2011) ISSN: 1532-3064 [Electronic] England
• PMID: 21367595 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Erythromycin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage)
• Bronchiectasis (drug therapy, physiopathology)
• Disease Progression
• Dose-Response Relationship, Drug
• Erythromycin (administration & dosage)
• Female
• Humans
• Male
• Middle Aged