Efficacy of Long-term Intermittent Azithromycin Therapy in Reducing the Frequency of Exacerbation in Severe COPD

13 Jul, 21

Introduction

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent event and the mortality risk increases with its frequency particularly when patients require hospitalization. Use of prophylactic antibiotics to prevent acute exacerbations (AECOPD) has increased. Azithromycin has also been shown to be useful in the treatment of patients with bronchiectasis and chronic bronchial infection by Pseudomonas aeruginosa.

Aim

To determine whether long-term intermittent azithromycin therapy reduces the frequency of exacerbation in severe chronic obstructive pulmonary disease (COPD).

Patient Profile

Patients with severe COPD and a minimum of four acute exacerbations (AECOPD) per year or chronic bronchial colonization by Pseudomonas aeruginosa

Methods

Retrospective analysis

Results

No clinically significant adverse events were observed during azithromycin treatment.
Azithromycin therapy significantly reduced the number of AECOPD (P <0.001), hospitalizations (P < 0.001), and cumulative annual days of hospital stay (P = 0.01).

Figure 1: Number of AECOPD with and without azithromycin, overall and according to the group of potentially pathogenic microorganisms isolated from sputum samples before initiation of azithromycin

Table 1: Number of hospitalizations due to respiratory disease, and days of hospitalization with and without azithromycin, overall and according to the group of potentially pathogenic microorganisms isolated from sputum samples before initiation of azithromycin

Variable Overall (n = 20)	0–12 months without azithromycin			12–24 months with azithromycin		% Red	P
Variable Overall (n = 20)	Total		Mean ± SD	Total	Mean ± SD	% Red	P
Hospitalizations (n)	72	3.6 ± 1.9		28	1.4 ± 1.5	61.2	0.001
Hospital stay (days)	874	43.7 ± 21.4		500	25.0 ± 32.2	42.8	0.013
Common PPM group (n = 7)
Hospitalizations (n)	29	4.1 ± 2.6		9	1.2 ± 1.4	70.8	0.04
Hospital stay (days)	309	44.1 ± 17.5		133	19 ± 25	57	0.05
Pseudomonas aeruginosa group (n = 9)
Hospitalizations (n)	31	3.4 ± 1.6		17	1.8 ± 1.7	47.1	0.08
Hospital stay (days)	454	50.4 ± 23.9		306	34.0 ± 38.5	32.5	0.23

Significant improvemnet in AECOPD and hospitalization was seen in patients with exacerbations caused by common potentially pathogenic microorganisms and patients colonized by P. aeruginosa

Figure 2: % Reduction in AECOPD and hospitalization in in patients with exacerbations caused by common potentially pathogenic microorganisms and in patients colonized by P. aeruginosa

Conclusion

Long-term intermittent azithromycin therapy administered three times a week at a dosage of 500 mg resulted in significant reductions in AECOPD, number of hospitalizations, and days of hospital stay in patients with severe COPD and repeated AECOPD.
The improvement was significant in patients with AECOPD associated with common potentially pathogenic microorganisms, and in patients with chronic bronchial colonization by P. aeruginosa
It was well tolerated
Long-term intermittent azithromycin therapy may be useful in the treatment of patients with severe COPD and frequent exacerbations.

References

International Journal of COPD 2011:6 449-456