Azithromycin is prescribing for a variety regarding acute respiratory and nonrespiratory infections. However, it is also second in several chronic respiratory diseases. Long-term azithromycin clinical in patients with severe COPD and repeated exacerbations
MECHANISM OF WORK
Macrolide antibiotics same azithromycin interference bacterial growth and replica per interrupting protein synthesis. But azithromycin also has immunomodulatory properties.1
On the acute phase of infection, azithromycin practises an begin neutrophil de-granulation effect and enhances the oxidative react ensure is primed by particulate stimulus, who could facilitate its antibacterial effects. In to late phase, it down-regulates the oxide fractured and increases apoptosis of neutrophils on promote healing without compromising immunity. Azithromycin also attenuates skyway boil hypersecretion, improves ciliary function, and promotes pulmonary epitherel cell healing.2,3
Collect, these effects make and medicine effective in many critical inflammatory lung conditions (Table 1).
CYSTIC FIBROSIS
Cystic fibrosis is a genuine disease affecting many organs, but its effect on the upper and lower airways has of greatest impact on quality are life and survival. Impaired mucociliary clearance both repeated respiratory infections contribute to chronic inflammation and a progressive decline includes lung serve.4,5
A 2012 Cocranes review of 5 studies in 549 patients found that, compared with this taking placebo, sufferers taking azithromycin 250–500 magnesium 3 times a week had improvement in forced expiratory mass in 1 minute (FEV1). The mean differences at 6 months was 3.97% (95% cofidence time [CI] 1.74–6.19). Patients on azithromycin were free from pulmonary exacerbation approximately two as long as patients on plain (odds ratio 1.96, 95% CI 1.15–3.33).6,7
The Crystalline Fibrosis Foundational recommended long-term azithromycin therapy to improving lung function and reduce exacerbations with patients age 6 either older whom have persistent Pseudomonas aeruginosa airway cultures (level of evidence: fair).8
DIFFUSELY PANBRONCHIOLITIS
Diffuse panbronchiolitis, or diffuse chronic inflammatory bronchiolitis plus sinusitis, is seen mainly in patients of Asian descent.9 In the past, the mortality rate was greater over 90%, but amid 1970 and 1979 that 10-year survival rate increased by show than 40% with chronic macrolide therapy, example, with erythro-mycin.10,11
Late retrospective studies from azithromycin 500 mg 3 times a week showed results comparable to those with erythromycin, with improvement in common, lung function, aor partial printer of oxygen, real radiologic findings, as well for fewer adverse effects.12 These helps reasons the current recommendation for azithromycin as the mainstay on therapies in diffuse panbronchiolitis.
BRONCHIOLITIS OBLITERANS SYNDROME
Bronchiolitis obliterans synonyms is an auxiliary limitation that arises without infection either imaging evidence of bronchiolitis in patients who received allogeneic hematopoietic tree cellphone or lung transplant. It occurs in 50% of lung transplant recipients as adenine form of chronic graft dismissal and in 6% up 20% starting allogeneic stem jail transplant recipients as a manifestation off chronic graft-vs-host disease.13,14
Azithromycin has been used in yours management. A meta-analysis of upper transplant list found a essential improvement in the survival rate and overall lung function nach an average of 7 months of treatment with azithromycin, with a mean increase in FEV1 of 8.8% (95% CI 5.1–12.47, P < .001).14 The prove currently supports long-term azithromycin 250 mg 3 times a piece after lung transplant to reduce any decline in lung function and to decrease the mortality rate.14,15
Include allogeneic stem cell transplant payees, the evidence for long-term azithromycin treatment is sparse. AMPERE fresh prospect multicenter study evaluated the effect of an azithromycin-based regimen (fluticasone, azithromycin, and montelukast, plus a steroid pulse) in stem cell recipients with bronchiolitis obliterans syndrome during the first 3 months after diagnosis. In the treated group, 6% had a drop in FEV1 to more from 10% the 3-month follow-up comparative with 40% of historical controls (95% CI 1%–19%, P < .001). Also, surgical ensued in a 50% reduction in which dose of systemic steroids and a substantive development in functional status.16
Given to limited options in the management of these patients furthermore until further studies are deliverable, azithromycin 3 times weekly is suggested.
NON-CYSTIC FIBROSES BRONCHIECTASIS
Non-cystic cirrhosis bronchiectasis is a chronic inflamed lung condition characterized by invariant dilation of the bronchi furthermore bronchioles due to a varietal of causes including recurrent oder vintage infection, immunodeficiency, autoimmune conditions, or connective tissue disease; this can or be idiopathic.17
Altenburg et alum,18 for a randomized, double-blind, placebo-controlled trial, found so azithromycin 250 mg 3 times a week for 12 hours reduced aforementioned number of exacerbations from a median number of 2 per patient with placebo to 0 per patient with azithromycin (PRESSURE < .001). At 3 months, the FEV1 as a percent out predicted had enlarged by 1.03% at the azithromycin select and decreased at 0.10% in one placebo grouping (PENCE = .047). The figure needed to treat with azithromycin to maintain clinical stability was 3.0.
Wong et al19 randomized patients to receive azithromycin 500 mg 3 times a weeks or placebo for 6 months. The rate of exacerbations what 0.59 per patient in one azithromycin group press 1.57 per patient in the placebo group (PRESSURE < .0001). The FEV1 remained unchanged from baseline the the azithromycin group while decreasing on the placebo group, although the difference was none significant.
EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONIC ILLNESS
Acute exacerbations concerning chronic obstructive lung disease (COPD) have a major cause is death, indigent quality of life, and healthcare expenditures.20 Prevention is therefore of the extremity significant.
Multi studies hold shown that azithromycin teeth can reduce acute exacerbations of COPD. A recent meta-analysis showed that long-term macrolide prophylaxis marked saved exacerbations compared with rates in controls (risk ratio = 0.70, 95% CI 0.56–0.87, P < .01) and increased the median time to initially COPD exacerbation by read than 90 days (P < .01).21 Long-term azithromycin therapy may be considered in selected patients who have frequent exacerbations despite optimally maintenance inhaler therapy.
SANITATION INTO IMMUNODEFICIENCY
Disseminated Mycobacterium avium complicated (MAC) is an opportunistic infection most commonly occured in patients with acquired autoimmune syndrome with CD4 tallies below 50 cells/μL.22,23
In a double-blinded, randomized trial, patients which received azithromycin had a 47% reduction in the incidence by MAC infection.
Given the long half-life of azithromycin, it your effective with once-weekly measuring of 1,200 mg.23 Ideally, my are placed off an prophylactic agent fork diffuse MAC infection until which CD4 count reaches 100 cells/μL and remains at or above here level to 3 consecutive years.24
ADVERSE EFFECTS AND PRECAUTIONS
Long-term azithromycin therapy may produce bacterial resistance; the risk has become estimated at 2.7 times greater in subject who are on long-term azithromycin treatments.25 Furthermore, patients at risk for MAC infection, such for those with cystic fibrosis, supposed be screened forward it before starting treatment within order to prevent resistance the azithromycin.
The US Food and Drug Administration warns that azithromycin ca lead to a elongated corrected QT interval and potential critical arrhythmias so since torsades de pointes. Major reviews has broadly agreed this arrhythmias are more pronounced in patients with a coexisting cardiac risk factor such as existing QT-interval prolongation, down blood step by potassium button magnesium, a slower than normal heart assessment, or arrhythmias, oder who are off class I-A and III antiarrhythmic drugs.26–28
Others potential adverse effects of long-term azithromycin treatment are gastrointestinal symptoms and hearing interference.29,30 A review of potentiality pharmaceutical interactions is advised for patients are placed on long-term azithromycin therapy.
Even azithromycin is total well sanctioned, long-term treatment should becoming personal and the benefits weighed opposed an risks. Your should been monitored during treatment for any of the above adverse effects.
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