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Antibiotic treatment a 'valuable option' to prevent COPD exacerbations

COPD patients routinely taking the antibiotic azythromycin alongside usual treatment have a reduced risk of exacerbations, find a new study.

The US study in 570 patients taking an oral daily 250mg dose of azithromycin, found that they had less frequent exacerbations, compared with 572 patients taking placebo, but had a slightly increased risk of experiencing reductions in their hearing.

Researchers randomly assigned participants aged least 40 years-old to azithromycin or placebo treatment. Participants had no hearing impairment, resting tachycardia, or apparent risk of prolongation of the corrected QT interval.

The median time to first acute exacerbation was 266 days for patients taking azithromycin and 174 days in those receiving placebo. The hazard ratio of having an acute exacerbation per patient-year in the azithromycin group compared with the placebo group was 0.73.

The study also found that more participants taking azithromycin developed a hearing decrement – (25%) than those in the placebo group (20%). But the authors argue ‘improvements in hearing that occurred on repeat testing … suggest that our criteria were too stringent and that the incidence of hearing decrements was overestimated in both groups.'

Study leader Dr Richard Albert, professor of medicine at the University of Colorado, said: ‘Adding azithromycin to the treatment regimen of patients who have had an acute exacerbation of COPD within the previous year or who require supplemental oxygen is a valuable option'.

NEJM 2011, published early online 25 Aug

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