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Prolonged use of a macrolide antibiotic minimize COPD exacerbations under a cloud

Prolonged use of a macrolide antibiotic minimize COPD exacerbations under a cloud According to a London-based study, prolonged usage of a macrolide antibiotic could possible minimize exacerbations in patients with moderate to severe COPD (chronic obstructive pulmonary disease) by as much as 35 percent.

It was found that there is a significant effect of low-dose macrolide therapy, minimizing exacerbation frequency, and severity with moderate to severe COPD, according to lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

From News-Medical.Net:

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.”

John Heffner, M.D., past president of the ATS, remarked observations that intervention might possibly reduce the frequency and severity of acute exacerbations in COPD showcase present significant public health implications.

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