Daily Dose of Common Antibiotic Makes Acute COPD Episodes Less Frequent, Study Says

A multicenter team that includes researchers from the University of Pittsburgh School of Medicine has found that patients with chronic obstructive pulmonary disease (COPD) had fewer episodes of acute worsening of their lung disease and a better quality of life if they took a daily dose of a commonly used antibiotic. The findings were reported in Aug. 25 issue of the New England Journal of Medicine.

Even patients who are treated with standard bronchodilator and steroid inhalers to control COPD symptoms commonly have one or more flare-ups of the disease each year, which means more doctor and hospital visits, lost work days, and reduced lung function, explained Frank Sciurba, a professor of medicine in Pitt’s School of Medicine and a leader of the local arm of the study.

The study was conducted by the COPD Clinical Research Network and led by Richard K. Albert of the University of Colorado Denver Health Sciences Center. More than 1,100 COPD patients from 17 sites in 12 academic centers participated in the trial. About half of the participants were randomly assigned to take the macrolide antibiotic azithromycin every day for a year, while the rest took a placebo daily for the same time period. The Pitt arm enrolled 91 participants.

The median time to first COPD exacerbation was 266 days in the azithromycin group and 174 days in the placebo group. Also, exacerbations occurred 27 percent less frequently in the azithromycin group. There was a slightly greater likelihood of hearing problems in the azithromycin group, which is a known risk of prolonged use of the antibiotic, and the presence of antibiotic-resistant organisms was detected in some patients, although the infection rate was not higher.

More research needs to be done to assess the safety of using azithromycin in COPD patients for longer than a year, and it’s not clear what impact that might have on antibiotic resistance, said trial coinvestigator John Reilly, a professor of medicine in Pitt’s School of Medicine.

According to the National Heart, Lung, and Blood Institute, COPD affects more than 12 million people in the United States and is now the third-leading cause of death in the United States. There currently is no cure, though a combination of drugs and lifestyle changes can help manage the symptoms.