Azithromycin maintenance therapy in patients with cystic fibrosis: a dose advice based on a review of pharmacokinetics, efficacy, and side effects.
Azithromycin maintenance therapy results in improvement of respiratory function in patients with cystic fibrosis (CF). In azithromycin maintenance therapy, several dosing schemes are applied. In this review, we combine current knowledge about azithromycin pharmacokinetics with the dosing schedules used in clinical trials in order to come to a dosing advise which could be generally applicable. We used data from a recently updated Cochrane meta analysis (2011), the reports of clinical trials and pharmacokinetic studies. Based on these data, it was concluded that a dose level of 22-30 mg/kg/week is the lowest dose level with proven efficacy. Due to the extended half-life in patients with CF, the weekly dose of azithromycin can be divided in one to seven dosing moments, depending on patient preference and gastro-intestinal tolerance. No important side effects or interactions with other CF-related drugs have been documented so far.
Central Hospital Pharmacy, The Hague, The Netherlands. e.wilms@ahz.nl
Erik B
EB
Wilms
Daniel J
DJ
Touw
Harry G M
HG
Heijerman
Cornelis K
CK
van der Ent
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D017963:Azithromycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D002986:Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000188:drug therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D018410:Pneumonia, Bacterial / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D017963:Azithromycin