Respiratory disease mainly affecting people who smoke now or have done so previously. It could become the third leading cause of death worldwide by 2020. People with COPD experience gradually worsening shortness of breath and cough with (phlegm) because of permanent damage to their airways and lungs. Those with COPD may have flare-ups (or exacerbations) most commonly with respiratory infections. Exacerbations may lead to further irreversible loss of lung function, as well as days off work, hospital admission, reduction in quality of life, or even death. We wanted to find out if giving antibiotics to prevent a flare-up ('prophylactic' antibiotics) would reduce the frequency of flare-ups and improve quality of life. Studies that were taken into consideration used either continuous prophylactic antibiotics (every day), or antibiotics that were used intermittently (three times per week) or pulsed (e.g. for five days every eight weeks)What evidence did we find? DEAR MAYO CLINIC: I have chronic obstructive pulmonary disease (COPD), and my doctor is recommending an antibiotic drug long term. ANSWER: For certain people with COPD, long-term use of an antibiotic drug — specifically azithromycin (Zithromax) — is a fairly new option to reduce exacerbations. Exacerbations are episodes when symptoms of COPD become worse than their usual day-to-day variation. Some exacerbations may be caused by a viral or bacterial infection. An exacerbation, if severe, can lead to hospitalization and even respiratory failure and death. For people with COPD, short-term use of antimicrobials — antibiotics and antiviral agents — can help fight respiratory infections, such as acute bronchitis, pneumonia and influenza, and be used as part of the treatment of an exacerbation. A 2011 study indicated that long-term, continued use of azithromycin helps prevent COPD exacerbations — even for those who don’t have an active respiratory infection. In addition to its antibacterial effects, azithromycin has anti-inflammatory and immune-modulating effects that likely contribute to its ability to improve COPD management.
Published in the March 2012 issue of Today’s Hospitalist WHEN HOSPITALISTS go to discharge a patient they have been treating for a COPD exacerbation, they should consider adding one more daily pill to the medical regimen. According to a study published last year in the New England Journal of Medicine, taking 250 mg of azithromycin (Zithromax) once a day for a year is one of the best things COPD patients at risk for an acute exacerbation can do to ward off future episodes. Albert, MD, a pulmonologist and chief of medicine at Denver Health, says the large, multiyear, multicenter, NIH-funded study proved both the efficacy and the safety of adding the macrolide antibiotic to COPD treatment regimens. Contrary to expectations, the study found that even when a generally older population took once-a-day azithromycin, there were no GI problems. And while the medication was associated with a small decrement in hearing, that was frequently reversible ” even when the medication was continued. Both the study and the accompanying editorial concluded that the benefits of taking daily azithromycin outweighed the risks. Albert adds, is that while a greater percentage of patients taking the antibiotic for a year (compared to those on placebo) had macrolide-resistant organisms cultured from nasal swabs, the antibiotic markedly reduced nasal colonization. That meant that there were actually fewer subjects with macrolide-resistant organisms in the treatment group. Role for hospitalists Hospitalists often treat the subset of COPD patients targeted in the study: those who have suffered at least one acute exacerbation that brought them to the hospital within the previous year and/or those requiring supplemental oxygen. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. COPD is the sixth leading cause of death worldwide and is the only condition in the top 10 causes of death that has an increasing prevalence and mortality. Azithromycin for prevention of exacerbations of COPD. Listing a study does not mean it has been evaluated by the U. The cost of health care for patients with COPD in the U. is approximately $6.5 billion per year; acute exacerbations account for between 31% and 68% of that cost. BACKGROUND: The prevalence, morbidity, mortality, and treatment cost of COPD are high and increasing. Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JA Jr, Criner GJ, Curtis JL, Dransfield MT, Han MK, Lazarus SC, Make B, Marchetti N, Martinez FJ, Madinger NE, Mc Evoy C, Niewoehner DE, Porsasz J, Price CS, Reilly J, Scanlon PD, Sciurba FC, Scharf SM, Washko GR, Woodruff PG, Anthonisen NR; COPD Clinical Research Network. Macrolide antibiotics may reduce the frequency and/or severity of COPD exacerbations, as a result of their antibacterial properties and anti-inflammatory effects. Albert RK, Connett J, Curtis JL, Martinez FJ, Han MK, Lazarus SC, Woodruff PG. Long-term administration of macrolide antibiotics in patients with a number of other pulmonary disorders has resulted in clinically important improvements. Han MK, Tayob N, Murray S, Dransfield MT, Washko G, Scanlon PD, Criner GJ, Casaburi R, Connett J, Lazarus SC, Albert R, Woodruff P, Martinez FJ. Mannose-binding lectin deficiency and acute exacerbations of chronic obstructive pulmonary disease. It is hypothesized that administration of a macrolide antibiotic (azithromycin) for 1 year, when added to usual care, will decrease the frequency and severity of COPD exacerbations. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. If this hypothesis is correct, the proposed treatment is also expected to reduce the mortality of COPD patients.
Even then, the calculated risk of cardiovascular death associated with long term azithromycin prophylaxis in COPD patients is reported to be 1. Aug 15, 2001. Acute exacerbations of chronic obstructive pulmonary disease COPD are. Azithromycin Zithromax, 500 mg initially, then 250 mg daily.