Azithromycin for prevention of exacerbations of COPD

January 01, 0001

Azithromycin for prevention of exacerbations of COPD

These US and Canadian investigators performed a randomized trial to determine whether azithromycin decreased the frequency of exacerbations in participants with COPD who had an increased risk of exacerbations but no hearing impairment, resting tachycardia, or apparent risk of prolongation of the corrected QT interval.

They found: "A total of 1577 subjects were screened; 1142 (72%) were randomly assigned to receive azithromycin, at a dose of 250 mg daily (570 participants), or placebo (572 participants) for 1 year in addition to their usual care. The rate of 1-year follow-up was 89% in the azithromycin group and 90% in the placebo group. The median time to the first exacerbation was 266 days among participants receiving azithromycin, as compared with 174 days among participants receiving placebo. The frequency of exacerbations was 1.48 exacerbations per patient-year in the azithromycin group, as compared with 1.83 per patient-year in the placebo group (P=0.01), and the hazard ratio for having an acute exacerbation of COPD per patient-year in the azithromycin group was 0.73. The scores on the St. George's Respiratory Questionnaire (on a scale of 0 to 100, with lower scores indicating better functioning) improved more in the azithromycin group than in the placebo group (a mean decrease of 2.8 vs. 0.6); the percentage of participants with more than the minimal clinically important difference of -4 units was 43% in the azithromycin group, as compared with 36% in the placebo group. Hearing decrements were more common in the azithromycin group than in the placebo group (25% vs. 20%)."

The authors concluded: "Among selected subjects with COPD, azithromycin taken daily for 1 year, when added to usual treatment, decreased the frequency of exacerbations and improved quality of life but caused hearing decrements in a small percentage of subjects. Although this intervention could change microbial resistance patterns, the effect of this change is not known."

The concerns about eventual emergence of resistance and the effects on hearing should give pause.

For the full abstract, click here.

N Engl J Med 365:689-698, 25 August 2011 © 2011 to the Massachusetts Medical Society
Azithromycin for Prevention of Exacerbations of COPD. Richard K. Albert, John Connett, William C. Bailey, et al. Correspondence to Dr. Albert: ralbert@dhha.org

Category: R. Respirtory. Keywords: chronic obstructive pulmonary disease, COPD, exacerbation, prevention, azithromycin, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 6 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.