Antibiotic may provide benefit for treatment of respiratory disorder

March 26, 2013, The JAMA Network Journals

Among patients with the lung disorder non-cystic fibrosis bronchiectasis, treatment with the antibiotic erythromycin resulted in improvement in symptoms but also increased the risk of antibiotic resistance, according to a study appearing in the March 27 issue of JAMA.

David J. Serisier, M.B.B.S., D.M., F.R.A.C.P., of Mater Adult Hospital, South Brisbane, Australia, and colleagues tested the hypothesis that low-dose would reduce pulmonary exacerbations in patients with non-CF bronchiectasis with a history of frequent exacerbations.

The study consisted of a 12-month randomized controlled trial of erythromycin in currently nonsmoking, with non-CF bronchiectasis with a history of 2 or more infective exacerbations in the preceding year. The study was undertaken between October 2008 and December 2011 in a university teaching hospital. Patients received twice-daily erythromycin ethylsuccinate (400 mg) or matching placebo. The primary measured outcome was the annualized average rate of protocol-defined pulmonary exacerbations (PDPEs) per patient. Secondary outcomes included macrolide resistance and lung function.

Six-hundred seventy-nine patients were screened, 117 were randomized (58 placebo, 59 erythromycin), and 107 (91.5 percent) completed the study. The researchers found that erythromycin significantly reduced PDPEs (76 for the erythromycin group vs. 114 for the ; average 1.29 vs. 1.97 respectively, per patient per year). The number of patients treated with erythromycin who had zero PDPEs was 20 (vs. 16 for placebo), and 10 patients had more than 2 PDPEs (vs. 18, respectively).

Erythromycin also reduced PDPEs in the prespecified subgroup with baseline Pseudomonas aeruginosa airway infection. In addition, there were significantly fewer total respiratory events (total PDPEs plus non-PDPEs) in the erythromycin group (111 vs. 176 for placebo; average, 1.88 vs. 3.03 per patient per year).

"Erythromycin reduced 24-hour sputum production and attenuated [lessened] lung function decline compared with placebo. Erythromycin increased the proportion of macrolide-resistant oropharyngeal streptococci," the authors write.

"In conclusion, long-term low-dose erythromycin significantly reduced exacerbations, protected against decline, reduced sputum production, and significantly increased macrolide resistance in oropharyngeal streptococci. The bacterial resistance caused by macrolide therapy mandates a cautious application of this therapy in clinical practice. Further studies are needed to evaluate the possibility that P aerugmosa-infected individuals with frequent exacerbations may represent an appropriate subgroup for limitation of this therapy."

"The important issues for clinicians are to determine which patients with bronchiectasis should be prescribed a macrolide and which macrolide should be used," writes J. Stuart Elborn, M.D., and Michael M. Tunney, Ph.D., of Queen's University Belfast, United Kingdom, in an accompanying editorial.

"In the trials in this issue of JAMA, patients were recruited if they had frequent exacerbations, defined as at least 2 or 3 exacerbations in the previous year. Therefore, patients with bronchiectasis who have 2 or more exacerbations in the previous year should be considered for treatment. Erythromycin and azithromycin are both effective for reducing exacerbations and have similar effects on antimicrobial resistance. The effect of long-term macrolide use on in these patients is not clear but should dissuade clinicians from prescribing macrolides for patients whose clinical characteristics differ from those for whom a positive effect was seen in these studies."

Explore further: New treatment offers hope to patients with chronic lung disorder bronchiectasis

More information: JAMA. 2013;309(12):1260-1267
JAMA. 2013;309(12):1295-1296

Related Stories

New treatment offers hope to patients with chronic lung disorder bronchiectasis

August 16, 2012
Researchers have identified a promising new treatment for non-cystic fibrosis bronchiectasis, a long-term lung disorder which causes persistent coughing and breathlessness. The results, published in the Lancet, could represent ...

Researcher discovers antibiotic useful for localized treatment of bone wear

August 9, 2011
Total joint replacement surgeries can help relieve joint pain common in people with conditions like osteoarthritis. But sometimes, the debris from prosthetic joints leads to aseptic loosening, or disintegration of surrounding ...

Antibiotic therapy improves moderate exacerbations of mild-to-moderate COPD

September 7, 2012
Antibiotic treatment with amoxicillin/clavulanate improves moderate exacerbations in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) and significantly prolongs the time between exacerbations, according ...

Recommended for you

Deadly Rift Valley fever: New insight, and hope for the future

July 19, 2018
Health control measures alone could be ineffective in the long term fight against the deadly Rift Valley fever which affects both humans and animals, a new study in the journal PNAS reports.

Yeast species used in food industry causes disease in humans

July 19, 2018
A major cause of drug-resistant clinical yeast infections is the same species previously regarded as non-pathogenic and commonly used in the biotechnology and food industries. The study, published on July 19th in the open-access ...

New guidelines to diagnose, manage rare endocrine disorders

July 19, 2018
International guidelines have been published for the first time to help doctors around the globe diagnose and manage patients with a very rare set of endocrine diseases known as pseudohypoparathyroidism and its related disorders, ...

Overuse of antibiotics not what the doctor ordered

July 19, 2018
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community ...

Alcohol-related cirrhosis deaths skyrocket in young adults

July 18, 2018
Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

Childhood abuse linked to greater risk of endometriosis, study finds

July 17, 2018
Endometriosis, a painful condition that affects one in 10 reproductive-age women in the U.S., has been linked to childhood physical and sexual abuse, according to findings published today in the journal Human Reproduction.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.