Long-term antibiotics reduce COPD exacerbations, raise questions

Nov 21, 2008

Long-term use of a macrolide antibiotic may reduce the frequency of exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD) by as much as 35 percent, according to a London-based study.

"Our results show a significant effect of low-dose macrolide therapy, reducing exacerbation frequency and severity with moderate to severe COPD," wrote lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

The encouraging news comes on the heels of World COPD Day 2008 and a new report from the Centers for Disease Control and Prevention (CDC) that detailed the rising number of deaths related to COPD. More women than men now die of COPD, and while death rates for men have leveled, the rate is still increasing for women, according to the CDC.

The latest study is the first ever year-long randomized, double-blind, placebo-controlled study of the effects of erythromycin in COPD. The results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.

The researchers assessed and followed 109 patients with moderate to severe COPD for a year, after randomly assigning them to receive either a placebo or a twice daily 250 mg dose of erythromycin. The patients recorded their exacerbations and hospitalizations in a daily diary card, and they were assessed using spirometry, sputum testing and blood testing for lung function, bacterial infection and markers of inflammation.

The researchers found that not only did the patients randomized to receive erythromycin have fewer exacerbations, but among the patients studied, 60 percent of the exacerbations that occurred were within the placebo group. While the number of exacerbation-related hospitalizations was small, more than twice as many occurred among the placebo group—14 versus 6. The median duration of exacerbations from onset to resolution of symptoms was 9 days in the erythromycin group and 13 days in the placebo group.

"Our results did not allow us to determine a mechanism for these findings. However based on in-vitro studies we suspect that the mechanism is likely to involve the anti-inflammatory properties of erythromycin," noted Dr. Seemungal.

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. "In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class," wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. "Balancing benefit against harm could pose a dilemma for which there might be no clear answers."

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

"Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications," observed John Heffner, M.D., past president of the ATS. "Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone."

"Many patients with advanced COPD receive highly potent, extended spectrum antibiotics during acute exacerbations," commented Dr. Heffner. "The relative risks of breeding resistance with a long-term preventative use of erythromycin versus more frequent short-term dosing of highly potent antibiotics for acute exacerbations require careful analysis. If future studies demonstrate similar efficacy of prolonged erythromycin therapy, especially if patients are already receiving inhaled steroids and long-acting bronchodilators, the benefits likely will outweigh the risks."

Source: American Thoracic Society

Explore further: Evidence lacking for long-term opioid use in low back pain

add to favorites email to friend print save as pdf

Related Stories

Image: Grand Canyon geology lessons on view

5 minutes ago

The Grand Canyon in northern Arizona is a favorite for astronauts shooting photos from the International Space Station, as well as one of the best-known tourist attractions in the world. The steep walls of ...

Roman dig 'transforms understanding' of ancient port

15 minutes ago

(Phys.org) —Researchers from the universities of Cambridge and Southampton have discovered a new section of the boundary wall of the ancient Roman port of Ostia, proving the city was much larger than previously ...

Book offers simplified guide to shale gas extraction

22 minutes ago

The new book, "Science Beneath the Surface: A Very Short Guide to the Marcellus Shale," attempts to offer a reader-friendly, unbiased, scientific guide needed to make well-informed decisions regarding energy ...

First radar vision for Copernicus

25 minutes ago

Launched on 3 April, ESA's Sentinel-1A satellite has already delivered its first radar images of Earth. They offer a tantalising glimpse of the kind of operational imagery that this new mission will provide ...

Recommended for you

Pyridoxine-doxylamine drug safety data lacking

21 hours ago

(Medical Xpress)—The most commonly prescribed drug for pregnant women suffering from morning sickness in their first trimester does not prevent birth defects even though drug safety data says it does, according to research ...

FDA approves new type 2 diabetes drug

Apr 15, 2014

(HealthDay)—Millions of Americans with type 2 diabetes have a new treatment option with the U.S. Food and Drug Administration's approval Tuesday of a once-weekly injectable drug, Tanzeum.

User comments : 0

More news stories

Firm targets 3D printing synthetic tissues, organs

(Medical Xpress)—A University of Oxford spin-out, OxSyBio, will develop 3D printing techniques to produce tissue-like synthetic materials for wound healing and drug delivery. In the longer term the company ...

Survival hope for melanoma patients thanks to new vaccine

(Medical Xpress)—University of Adelaide researchers have discovered that a new trial vaccine offers the most promising treatment to date for melanoma that has spread, with increased patient survival rates and improved ability ...

Naps help infants learn

Sleep is essential in helping young children apply what they learn, according to new research by Rebecca Gómez, associate professor in the UA Department of Psychology. In this Q&A, she talks about her new ...

Robotics goes micro-scale

(Phys.org) —The development of light-driven 'micro-robots' that can autonomously investigate and manipulate the nano-scale environment in a microscope comes a step closer, thanks to new research from the ...

Biologists help solve fungi mysteries

(Phys.org) —A new genetic analysis revealing the previously unknown biodiversity and distribution of thousands of fungi in North America might also reveal a previously underappreciated contributor to climate ...