Navigation Links
Long-term antibiotics reduce COPD exacerbations, raise questions
Date:11/20/2008

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 group14 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."


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. Smoking may strongly increase long-term risk of eye disease
2. Long-Term Fatigue Plagues Cancer Survivors
3. Dont Ignore Tough or Long-Term Stomach Pain
4. Shaking may cause brain damage and serious long-term effects to infants
5. Sexual function affected by stem cell transplant according to long-term study
6. Smoking can harm the long-term effects of some oral surgery procedures
7. Childhood Obesity Epidemic a Long-Term Challenge
8. Conseco to Host Follow-Up Long-Term Care Conference Call
9. New Report Finds Information Technology Essential But Not Sufficient in Long-Term Care
10. No Link Between Amateur Boxing, Long-Term Brain Damage
11. No strong evidence linking amateur boxing with long-term brain injury
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/29/2016)... ... April 29, 2016 , ... Dr. Robert Mondavi, one of the ... smiles. Cosmetic dentistry is a fast-growing field as more patients are discovering the many ... learn more about the options currently available to them and which ones might work ...
(Date:4/29/2016)... ... , ... Reltok Nasal Products proudly announces that Boston Medical Products, Inc., a ... throat specialty, has added the KOTLER NASAL AIRWAY™ to its diverse product line. , ... patented safety device secured by nasal surgeons onto the floor of the nasal passages, ...
(Date:4/29/2016)... ... April 29, 2016 , ... ... growth round of funding led by Eastside Partners, with participation from existing investor ... growing customer base and accelerate its technology and product roadmap. , ...
(Date:4/29/2016)... ... April 29, 2016 , ... Regenerative Medicine Solutions ... to Work employee satisfaction survey, earning them second place for Tampa’s Best Places to ... employees. , “This is a great accomplishment for our team,” says RMS Human ...
(Date:4/29/2016)... ... April 29, 2016 , ... The infertility specialists at HRC Fertility/Orange County (HRC/OC) ... Daniel A. Potter -- are proud of the recent release of their 2014 in ... SART published the latest verified data for 375 U.S. member clinics. *Preliminary ...
Breaking Medicine News(10 mins):
(Date:4/29/2016)... -- Glycotope GmbH, a clinical-stage immuno-oncology company ... of Dr. Alfredo Zurlo as Chief Medical ... many years clinical experience and a proven track record ... was at Mologen AG where he was Chief Medical ... Zurlo held various positions at F Hoffmann La Roche ...
(Date:4/28/2016)... 2016 Research and Markets has ... Products Market 2016-2020" report to their offering. ... The global plastic surgery products market is expected ... period 2016-2020. , ,The growing adoption of laser in ... of the market. Lasers are used to treat a ...
(Date:4/28/2016)... YORK , April 28, 2016 ... online consumer insights on healthcare, announced today that it ... their report Cool Vendor in Life Sciences, 2016, ... April 15, 2016.  The report focuses on life-science- oriented ... gain insight from patients and doctors, confirm medication ingestion, ...
Breaking Medicine Technology: