Effect of Azithromycin on Pulmonary Function in Patients With Cystic Fibrosis Uninfected With &lt;emph type="ital"&gt;Pseudomonas aeruginosa&lt;/emph&gt;&lt;subtitle&gt;A Randomized Controlled Trial&lt;/subtitle&gt;

Saiman, Lisa; Anstead, Michael; Mayer-Hamblett, Nicole; Lands, Larry C.; Kloster, Margaret; Hocevar-Trnka, Jasna; Goss, Christopher H.; Rose, Lynn M.; Burns, Jane L.; Marshall, Bruce C.; Ratjen, Félix

doi:10.1001/jama.2010.563

Cited by 301 publications

(206 citation statements)

References 31 publications

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“…Recently, in a multicentre, randomised, double-blind, placebo-controlled trial, 260 CF patients, not infected with P. aeruginosa, were randomised in a 1:1 ratio to azithromycin 250 mg or 500 mg (based on body weight) 3 days per week, or placebo, for a period of 24 weeks. Azithromycin treatment did not improve pulmonary function, suggesting that the beneficial effect of azithromycin in CF is mainly due to its activity against P. aeruginosa [36]. However, it should be noted that the vast majority of the recruited patients had very good lung function (mean forced expiratory volume in 1 s (FEV1) nearly 100% predicted in both groups), thus reducing the chance of improving lung function with any intervention.…”

Section: Cystic Fibrosismentioning

confidence: 93%

“…The possibility that macrolides might modify the neutrophilic inflammatory response in CF was first investigated in the early 2000s. Since then, a number of clinical trials have confirmed their beneficial effects both in adults and children [31][32][33][34][35][36][37]. Recently, in a multicentre, randomised, double-blind, placebo-controlled trial, 260 CF patients, not infected with P. aeruginosa, were randomised in a 1:1 ratio to azithromycin 250 mg or 500 mg (based on body weight) 3 days per week, or placebo, for a period of 24 weeks.…”

Section: Cystic Fibrosismentioning

confidence: 99%

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Long-term macrolide treatment for chronic respiratory disease

2012

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Long-term macrolide treatment was first shown to alter the natural history of diffuse panbronchiolitis (DPB) in the late 1980s. Since then, macrolides have been demonstrated to exert antiinflammatory and immunomodulatory activity in addition to being antimicrobial. Indeed, their spectrum of action extends to the regulation of leukocyte function and production of inflammatory mediators, control of mucus hypersecretion, resolution of inflammation and modulation of host defence mechanisms. As such, the potential benefit of macrolide antibiotics has been evaluated in a variety of chronic respiratory diseases. The best studied condition is cystic fibrosis, of which there have been six randomised controlled trials showing evidence of benefit. However, most of the studies were limited by small numbers of patients and short follow-up. More recently, landmark studies have demonstrated the efficacy of azithromycin in reducing the risk of acute exacerbations in patients with chronic obstructive pulmonary disease, but the optimal duration and dosing of macrolide treatment remain uncertain.With the exception of patients with DPB and cystic fibrosis, until clear evidence of efficacy is available, the long-term use of macrolides should be limited to highly selected patients after careful evaluation of benefit and harm, or in the context of randomised controlled clinical trials. @ERSpublications Several studies evaluating macrolide antibiotics for the treatment of chronic respiratory diseases are underway

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Section: Cystic Fibrosismentioning

confidence: 93%

Section: Cystic Fibrosismentioning

confidence: 99%

Long-term macrolide treatment for chronic respiratory disease

2012

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“…The presence of specific signs and symptoms were collected at the time of prescribing a new antibiotic to evaluate whether the event qualified as a study-defined pulmonary exacerbation [27,28]. In brief, an exacerbation was defined as receiving new antibiotic treatment plus 1 or 2 of the 2 major criteria ( 10% decrease in FEV 1 from 6-month baseline, or oxygen saturation <90%, or 5% decline) or 2 or more of the 8 minor criteria (new or increased: cough, fatigue, chest congestion or sputum, respiratory symptoms or adventitial sounds; decreased: activity, appetite, or weight).…”

Section: Data Collectionmentioning

confidence: 99%

Outcomes and Treatment of Chronic Methicillin-ResistantStaphylococcus aureusDiffers by Staphylococcal Cassette Chromosomemec(SCCmec) Type in Children With Cystic Fibrosis

et al. 2014

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“…The mechanism of macrolides effect on CF lung disease is unknown. The possibility that macrolides might modify the neutrophilic inflammatory response in CF was investigated and their beneficial effects have been confirmed in a number of clinical trials both in adults and children [12][13][14][15][16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

Long term azithromycin therapy in patients with cystic fibrosis

Emiralioğlu¹,

Öztürk²,

Yalçın³

et al. 2016

Turk J Pediatr

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Inflammation is a central contributor to the pathogenesis of cystic fibrosis (CF) pulmonary disease; so limiting the excessive production of inflammatory mediators represents a major therapeutic strategy for slowing the decline in lung function and improving survival. The macrolide antibiotic azithromycin (AZM) has anti-inflammatory properties and immunomodulatory effects that may be beneficial in CF. The aim of this study was to document the long term use of AZM effect on pulmonary function, nutritional status and number of pulmonary exacerbations in patients with CF. Twenty four patients with CF aged 4-23 years followed at Hacettepe University Department of Pediatric Pulmonology between May 2007-December 2014enrolled in the study from 630 CF patients. They received 10 mg/kg/day of AZM three times a week. Pulmonary function parameters, sputum cultures, body mass index (BMI) Z scores and number of pulmonary exacerbations were analyzed at different time intervals (at the visits at months 6, 9 and 12).Median age of the patients was 14.7 (range 4-23 years) years and median treatment duration was 14 months (range 6-60 months). Initially, median FEV1% was found 68% (range 30%-100%), BMI was found 17.05 (range 13.3-26.5) and oxygen saturation was found 95% (range 84%-99%). At the end of the 6th, 9th and 12th months of the AZM therapy; no significant differences in FEV1% and oxygen saturation parameters were found compared to the initial time, however BMI increased significantly (p=0.03), also the number of pulmonary exacerbations (p<0.001) and severe exacerbations (p<0.001) needing intravenous antibiotic treatment were significantly reduced at the 6th and 12th month. At the end of the 12th month of AZM; Methicillin sensitive S. aureus (MSSA) colonization was significantly increased (p=0.005) and increased macrolide resistance was detected (p=0.008).Although, this study could not be designed as a placebo controlled study, the results showed that at least 6 months of AZM treatment led to a significiant reduction in the number of pulmonary exacerbations requiring antibiotics and improvement on nutritional status. Despite increased P. aeruginosa antibiotic resistance and MSSA colonization rates, the lower incidence of acute exacerbations in patients receiving AZM is an important and clinically relevant measure of beneficial effect. Therefore, long term use of AZM may be considered to slow pulmonary deterioration in CF patients with P. aeruginosa colonization.

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Effect of Azithromycin on Pulmonary Function in Patients With Cystic Fibrosis Uninfected With <emph type="ital">Pseudomonas aeruginosa</emph><subtitle>A Randomized Controlled Trial</subtitle>

Abstract: clinicaltrials.gov Identifier: NCT00431964.

Cited by 301 publications

References 31 publications

Long-term macrolide treatment for chronic respiratory disease

Long-term macrolide treatment for chronic respiratory disease

Outcomes and Treatment of Chronic Methicillin-ResistantStaphylococcus aureusDiffers by Staphylococcal Cassette Chromosomemec(SCCmec) Type in Children With Cystic Fibrosis

Long term azithromycin therapy in patients with cystic fibrosis

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