No widespread use of macrolide antibiotics
Despite inhalation therapy, 20-50% of patients experience ≥1 exacerbation per year. Acute exacerbations of COPD (AECOPD) are associated with acute worsening of symptoms necessitating medical intervention. 20-25% of exacerbations require hospitalisation, which has a bad prognosis: 6% in-hospital mortality, 12% mortality within 3 months, and 35% risk of readmission. Macrolide antibiotics possess both anti-microbial and anti-inflammatory properties. The role of azithromycin for the prevention of COPD exacerbations was established in 2011 by the publication of a multicentre RCT, showing a 30% reduction of acute exacerbations during a chronic treatment with azithromycin. However, there has not been a widespread use of azithromycin. “That was mainly because of major safety concerns, being cardiac safety (QTc prolongation) and bacterial resistance”, explained Prof. Wim Janssens (University Hospital Leuven, Belgium)....
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