Improved lung function and body mass index associated with long-term use of Macrolide antibiotics.
BACKGROUND
A number of studies have suggested that the non-antimicrobial actions of macrolide antibiotics may be valuable in treating patients with cystic fibrosis. The use of long-term macrolide antibiotics for the management of CF patients colonised by Pseudomonas aeruginosa and progressive pulmonary disease was introduced into our clinic in 1997. A retrospective study was undertaken to assess of the impact of this therapy.


METHODS
Twenty patients with progressive pulmonary disease (>10% fall in FEV(1) over 12 months despite optimising conventional therapy) were commenced on Azithromycin, 250 mg daily during a 21-month period. At the time of assessment they had remained on therapy for a mean of 0.9 years. Changes in lung function, weight, body mass index (BMI) and frequency of pulmonary exacerbations were assessed. A group of 20 patients with stable lung function and matched as far as possible for age and sex was identified for comparison.


RESULTS
Pulmonary function increased significantly in the Azithromycin group with FEV1% predicted increasing from a mean of 50.2-59.1% (P=0.001) while FVC% predicted increase from 64.5 to 76.1% (P=0.002). There was small but non-significant fall in lung function in the comparison group. Body mass index increased by a mean of 1.1 in the Azithromycin group but remained unchanged in the comparison group. The number of pulmonary exacerbations requiring intravenous antibiotics declined by 48.3% in macrolide treated subjects compared to the pre-treatment period (P<0.025); frequency of exacerbations in the control group was unchanged.


CONCLUSIONS
Long-term Azithromycin treatment in patients with progressive deterioration in lung function appears to have led to an improvement in pulmonary function, increased body mass index and decreased the frequency of pulmonary exacerbations requiring intravenous antibiotics.
Pirzada
Omar M
OM
Cystic Fibrosis Service, Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.
McGaw
Jean
J
Taylor
Christopher J
CJ
Everard
Mark L
ML
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017963:Azithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D015992:Body Mass Index; D001982:Bronchial Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications*; D018450:Disease Progression; D004334:Drug Administration Schedule; D004739:England; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D011237:Predictive Value of Tests; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects*; D015430:Weight Gain / Q000187:drug effects
D000900:Anti-Bacterial Agents; D017963:Azithromycin