Document Detail


Macrolide antibiotics and survival in patients with acute lung injury.
MedLine Citation:
PMID:  22116799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value for patients with acute lung injury (ALI). We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with ALI.
METHODS: Secondary analysis of multicenter, randomized controlled trial data from the Acute Respiratory Distress Syndrome Network Lisofylline and Respiratory Management of Acute Lung Injury Trial, which collected detailed data regarding antibiotic use among participants with ALI.
RESULTS: Forty-seven of 235 participants (20%) received a macrolide antibiotic within 24 h of trial enrollment. Among patients who received a macrolide, erythromycin was the most common (57%), followed by azithromycin (40%). The median duration of macrolide use after study enrollment was 4 days (interquartile range, 2-8 days). Eleven of the 47 (23%) patients who received macrolides died, compared with 67 of the 188 (36%) who did not receive a macrolide (P = .11). Participants administered macrolides were more likely to have pneumonia as an ALI risk factor, were less likely to have nonpulmonary sepsis or to be randomized to low tidal volume ventilation, and had a shorter length of stay prior to trial enrollment. After adjusting for potentially confounding covariates, use of macrolide was associated with lower 180-day mortality (hazard ratio [HR], 0.46; 95% CI, 0.23-0.92; P = .028) and shorter time to successful discontinuation of mechanical ventilation (HR, 1.93; 95% CI, 1.18-3.17; P = .009). In contrast, fluoroquinolone (n = 90) and cephalosporin antibiotics (n = 93) were not associated with improved outcomes.
CONCLUSIONS: Receipt of macrolide antibiotics was associated with improved outcomes in patients with ALI.
Authors:
Allan J Walkey; Renda S Wiener
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2011-11-23
Journal Detail:
Title:  Chest     Volume:  141     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-03     Completed Date:  2012-06-25     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1153-9     Citation Subset:  AIM; IM    
Affiliation:
Boston University School of Medicine, The Pulmonary Center, Boston, MA 02118, USA. alwalkey@bu.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Acute Lung Injury / drug therapy*,  mortality
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
Azithromycin / therapeutic use*
Clarithromycin / therapeutic use*
Combined Modality Therapy
Drug Administration Schedule
Erythromycin / therapeutic use*
Female
Hospital Mortality
Humans
Length of Stay / statistics & numerical data
Macrolides / therapeutic use*
Male
Middle Aged
Pentoxifylline / analogs & derivatives*,  therapeutic use
Respiration, Artificial
Survival Rate
Tidal Volume / drug effects
Grant Support
ID/Acronym/Agency:
K07 CA138772/CA/NCI NIH HHS; K07 CA138772/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Macrolides; 114-07-8/Erythromycin; 6493-05-6/Pentoxifylline; 81103-11-9/Clarithromycin; 83905-01-5/Azithromycin; L1F2Q2X956/lisofylline
Comments/Corrections
Comment In:
Am J Respir Crit Care Med. 2013 Feb 15;187(4):446-7   [PMID:  23418328 ]
Chest. 2012 May;141(5):1131-2   [PMID:  22553255 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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