title: The Effects of Azithromycin in Treatment-Resistant Cough: A Randomized, Double-Blind, Placebo-Controlled Trial.
abstract: BACKGROUND
  Chronic cough is a common clinical problem worldwide. Although many patients have underlying precipitating conditions such as asthma, gastroesophageal reflux, or rhinitis, many remain symptomatic despite treating these conditions. New approaches are needed for the treatment of this group of patients.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial to determine whether 250 g of azithromycin three times a week for 8 weeks would affect the Leicester Cough Questionnaire (LCQ) score in 44 patients with treatment-resistant cough. Cough severity on a visual analog scale and bronchial exhaled nitric oxide were measured as secondary outcomes.
  
  
  RESULTS
  There was a clinically important improvement in LCQ score with azithromycin (mean change, 2.4; 95% CI, 0.5 to 4.2) but not placebo (mean change, 0.7; 95% CI, -0.6 to 1.9), but the between-group difference was not statistically significant (P = .12). There were no significant between-group differences for any of the secondary outcome measures. Looking at subgroups of responders, there was a large and significant improvement in LCQ score in patients with chronic cough and a concurrent diagnosis of asthma who were treated with azithromycin (mean, 6.19; 95% CI, 4.06 to 8.32).
  
  
  CONCLUSIONS
  Treatment with low-dose azithromycin for 8 weeks did not significantly improve LCQ score compared with placebo. The use of macrolides for treatment-resistant cough cannot be recommended from this study, but they may have a place in the treatment of chronic cough associated with asthma; this is worthy of further investigation.
  
  
  BACKGROUND
  WHO International Clinical Trials Registry; No.: ISRCTN75749391. URL: http://apps.who.int.
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: David
authors.initials: D
authors.lastname: Hodgson
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: John
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Catherine
authors.initials: C
authors.lastname: Reynolds
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Janet
authors.initials: J
authors.lastname: Oborne
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Garry
authors.initials: G
authors.lastname: Meakin
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Helen
authors.initials: H
authors.lastname: Bailey
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Dominick
authors.initials: D
authors.lastname: Shaw
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, England.
authors.forename: Kevin
authors.initials: K
authors.lastname: Mortimer
authors.affiliation: Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England. Electronic address: tim.harrison@nottingham.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Harrison
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D017963:Azithromycin / Q000627:therapeutic use*; D002908:Chronic Disease; D003371:Cough / Q000150:complications / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: airway inflammation; antibiotic therapy; cough
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