Long-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and
questions.
Author(s): Haworth CS(1), Bilton D(2), Elborn JS(3).
Affiliation(s): Author information:
(1)Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, CB23 3RE,
UK. Electronic address: charles.haworth@papworth.nhs.uk. (2)Department of
Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London, SW3 6NP,
UK. (3)Centre for Infection and Immunity, Queen's University of Belfast, 97
Lisburn Road, Belfast, BT9 7BC, Northern Ireland, UK.
Publication date & source: 2014, Respir Med. , 108(10):1397-408
Macrolide antibiotics have anti-inflammatory and immunomodulatory properties in
addition to antibacterial activity. Until recently, only a small number of
studies evaluating macrolides in patients with non-cystic fibrosis (CF)
bronchiectasis had been published. These were open-label, uncontrolled,
short-duration studies that included small numbers of patients. However, these
studies suggested that macrolides can reduce exacerbation frequency, reduce
sputum volume, and improve lung function in patients with non-CF bronchiectasis.
Three recently published randomised, double-blind, placebo-controlled studies
showed that macrolides (azithromycin or erythromycin) taken for between 6 and 12
months led to significant reductions in exacerbation rate and reduced the decline
in lung function. In all studies, macrolides were generally well tolerated. The
advantages of macrolide maintenance therapy need to be balanced against the
risks, which include emergence of bacterial resistance, cardiotoxicity and
ototoxicity. In addition, a key need is the consistent definition of endpoints
for studies in non-CF bronchiectasis, particularly the definition of
exacerbation, to allow systematic data analysis. Existing studies on the use of
low-dose macrolides in non-CF bronchiectasis are encouraging, but further studies
are needed to define the optimal agent, dose, duration for treatment, and the
patients likely to benefit and long-term safety.
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