Azithromycin to Prevent COPD Exacerbations

Posted by • August 26th, 2011

Exacerbations of chronic obstructive pulmonary disease (COPD) are a source of substantial morbidity. In a randomized, controlled trial involving patients with moderately severe COPD, daily treatment with azithromycin for 1 year was associated with fewer exacerbations.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in frequent visits to physicians’ offices and emergency rooms and numerous hospitalizations and days lost from work.

Clinical Pearls

How do acute exacerbations of COPD affect patient outcomes?

Patients who have acute exacerbations of COPD, as compared with patients with COPD who do not have acute exacerbations, have an increased risk of death, a more rapid decline in lung function, and reduced quality of life.

What was the effect of daily azithromycin treatment on the frequency of exacerbations in this study?

The frequency of exacerbations was 1.48 exacerbations per patient-year in the azithromycin group, as compared with 1.83 per patient-year in the placebo group (P=0.01), and the hazard ratio for having an acute exacerbation of COPD per patient-year in the azithromycin group was 0.73 (95% CI, 0.63 to 0.84) (P<0.001).

Table 2. Effect of Treatment for Chronic Obstructive Pulmonary Disease (COPD) on Hospitalization Rates, Emergency Department or Urgent Care Visits, and Unscheduled Office Visits.

Morning Report Questions

Q: How did daily treatment with azithromycin affect antibiotic resistance patterns among treated patients?

A: Cultures from 68% of the participants in the azithromycin group and 70% in the placebo group who were not colonized with selected respiratory pathogens at the time of enrollment but who became colonized during the course of the study were available for susceptibility testing (P=0.76), and the incidence of resistance to macrolides was 81% and 41% in the two groups, respectively (P<0.001).

Q: What adverse event was significantly more frequent among patients treated with azithromycin as compared to placebo in this study?

A: No significant differences were observed in the frequency of serious adverse events or of adverse events leading to discontinuation of the study drug, but an audiogram-confirmed hearing decrement occurred in 142 of the participants receiving azithromycin (25%), as compared with 110 of those receiving placebo (20%) (P=0.04 

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