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

• Published in: Respiratory medicine Vol. 105; no. 6; pp. 946 - 949
• Main Authors: Serisier, D.J., Martin, M.L.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.06.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; Biological and medical sciences; Bronchiectasis; Bronchiectasis - drug therapy; Bronchiectasis - physiopathology; Confidence intervals; Disease Progression; Dose-Response Relationship, Drug; Erythromycin; Erythromycin - administration & dosage; Female; Humans; Immunomodulation; Macrolides; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumology; Pulmonary/Respiratory; Respiratory system : syndromes and miscellaneous diseases; Streptococcus infections; Teaching hospitals; Bronchiectasis; Erythromycin; Macrolides; Immunomodulation; Human; Respiratory disease; Low dose; Long term; Macrolide; Antibiotic; Bronchus disease; Antibacterial agent; Pneumology
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2011.01.009

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. 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. 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. 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.