Effects of prolonged use of azithromycin in patients with cystic fibrosis: A meta-analysis

Florescu, Diana F.; Murphy, Peter J.; Kalil, André C.

doi:10.1016/j.pupt.2009.03.002

Cited by 55 publications

(47 citation statements)

References 32 publications

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“…The immunoregulation effect is demonstrated not only for erythromycin but also for other 14- and 15-membered ring macrolides (clarithromycin, roxithromycin, and azithromycin, respectively) [8]. A decrease in the frequency of infectious exacerbations was also demonstrated after treatment with azithromycin in patients with cystic fibrosis [10]. The heterogeneity of the two studies [17,19] may explain the absence of significant differentiation between the azithromycin treatment groups compared with the control.…”

Section: Discussionmentioning

confidence: 99%

“…The most common adverse effect during short-term treatment was gastrointestinal reactions [21]. A meta-analysis of long-term, small-dose azithromycin therapy in cystic fibrosis [10] showed that gastrointestinal reactions (nausea, diarrhea) were more frequent in the treatment group than in the control group. Some patients in the study of Albert et al [19] experienced hypoacusis, with a statistical significance between the azithromycin (25%) and control (20%) groups.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, long-term and small-dose macrolide therapy can improve the prognosis of diffuse panbronchiolitis [9], a chronic inflammatory airway disease. Systematic reviews have also indicated the beneﬁts of macrolides in the treatment of cystic ﬁbrosis [10] and noncystic fibrosis bronchiectasis [11]. …”

Section: Introductionmentioning

confidence: 99%

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Macrolide Therapy Decreases Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

Yao

Zhang

et al. 2013

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Background: Macrolide antibiotics have anti-inflammatory effects, and long-term administration may reduce chronic obstructive pulmonary disease (COPD) exacerbations. Objective: To investigate the effects of long-term treatment of macrolide therapy for COPD. Methods: We searched the PubMed and Embase databases to identify randomized controlled trials that evaluated the effect of macrolide therapy (of at least 2 weeks) for COPD. The primary outcome assessed was the frequency of acute exacerbations during follow-up. Results: Six trials involving 1,485 COPD patients were included in the analysis. Analysis of the pooled data of all 6 trials showed that macrolide administration reduced the frequency of acute exacerbations of COPD [risk ratio (RR) = 0.62; 95% CI 0.43-0.89, p = 0.01]. Subgroup analysis showed that only erythromycin might be associated with decreased COPD exacerbations (erythromycin: p = 0.04, azithromycin: p = 0.22, clarithromycin: p = 0.18). Moreover, macrolide therapy for 3 months did not significantly reduce the number of exacerbations (p = 0.18), whereas a beneficial effect was conclusive in the 6-month (p = 0.009) and 12-month (p = 0.03) treatment subgroups. In addition, nonfatal adverse events were more frequent in the macrolide treatment groups than in the controls (RR = 1.32; 95% CI 1.06-1.64, p = 0.01). However, related clinical factors had no influence on the overall result (p = 0.19). There was no publication bias among the included trials. Conclusions: Macrolide therapy was effective and safe in decreasing the frequency of exacerbations in patients with COPD. Treatment might provide a significant benefit but only when therapy lasts more than 6 months.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Macrolide Therapy Decreases Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

Yao

Zhang

et al. 2013

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“…Although AZM does not inhibit planktonic growth of the opportunistic pathogen Pseudomonas aeruginosa at therapeutically relevant doses, the antibiotic has nevertheless been found to have beneficial effects in the treatment of chronic P. aeruginosa lung infections in cystic fibrosis patients. The observed improvement of pulmonary function may result from a combination of several mechanisms, among which the anti-inflammatory effects and the antibiofilm and antivirulence properties of AZM appear to be most important (10,16,29,30,39,51). Beneficial effects of AZM have also been seen in experimental urinary tract infections caused by P. aeruginosa (1).…”

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confidence: 99%

Azithromycin Inhibits Expression of the GacA-Dependent Small RNAs RsmY and RsmZ in Pseudomonas aeruginosa

Pérez‐Martínez

Haas

2011

Antimicrob Agents Chemother

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Azithromycin at clinically relevant doses does not inhibit planktonic growth of the opportunistic pathogen Pseudomonas aeruginosa but causes markedly reduced formation of biofilms and quorum-sensing-regulated extracellular virulence factors. In the Gac/Rsm signal transduction pathway, which acts upstream of the quorum-sensing machinery in P. aeruginosa, the GacA-dependent untranslated small RNAs RsmY and RsmZ are key regulatory elements. As azithromycin treatment and mutational inactivation of gacA have strikingly similar phenotypic consequences, the effect of azithromycin on rsmY and rsmZ expression was investigated. In planktonically growing cells, the antibiotic strongly inhibited the expression of both small RNA genes but did not affect the expression of the housekeeping gene proC. The azithromycin treatment resulted in reduced expression of gacA and rsmA, which are known positive regulators of rsmY and rsmZ, and of the PA0588-PA0584 gene cluster, which was discovered as a novel positive regulatory element involved in rsmY and rsmZ expression. Deletion of this cluster resulted in diminished ability of P. aeruginosa to produce pyocyanin and to swarm. The results of this study indicate that azithromycin inhibits rsmY and rsmZ transcription indirectly by lowering the expression of positive regulators of these small RNA genes.

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“…In non-CF patients, azithromycin has been shown to decrease exacerbations and there is an improvementin spirometric measurement [12]. In CF patients a meta-analysis suggests that it improves lung function, especially in those patients colonized with Pseudomonas [13].…”

Section: Short Communicationmentioning

confidence: 99%

Bronchiectasis: A Correct Diagnosis Needed for Proper Management

Hashim¹

2014

Emergency Medicine

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Effects of prolonged use of azithromycin in patients with cystic fibrosis: A meta-analysis

Cited by 55 publications

References 32 publications

Macrolide Therapy Decreases Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

Macrolide Therapy Decreases Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

Azithromycin Inhibits Expression of the GacA-Dependent Small RNAs RsmY and RsmZ in Pseudomonas aeruginosa

Bronchiectasis: A Correct Diagnosis Needed for Proper Management

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