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Long-term, low-dose erythromycin in bronchiectasis subjects with frequent infective exacerbations.
MedLine Citation:
PMID:  21367595     Owner:  NLM     Status:  Publisher    
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
D J Serisier; M L Martin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-28
Journal Detail:
Title:  Respiratory medicine     Volume:  -     ISSN:  1532-3064     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-3-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ltd. All rights reserved.
Dept of Respiratory Medicine, Lvl 9, Mater Adult Hospital, Raymond Tce, South Brisbane, Qld. 4101, Australia; University of Queensland, Mater Health Services, South Brisbane, Qld. 4101, Australia.
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