Effect of Azithromycin on Patients with Diffuse Panbronchiolitis: Retrospective Study of 51 Cases

Abstract

Background Patients with diffuse panbronchiolitis (DPB) are routinely treated with erythromycin, clarithromycin, and roxithromycin. The clinical effect of azithromycin on DPB has not been confirmed in a large cohort. Objective The present study was undertaken to investigate the clinical effects of azithromycin on patients with DPB. Methods Fifty-one patients with DPB treated with azithromycin in Shanghai Pulmonary Hospital, China, from July 2001 to April 2007 were analyzed retrospectively. Azithromycin (500 mg a day) was administrated intravenously in the first 1-2 weeks, taken orally (500 mg, once a day) for 3 months, and tapered to 3 times a week for 6-12 months. The patients were followed up until September 1, 2009. The therapeutic effect, according to their clinical and radiological findings, arterial gas analysis, lung function, and sputum bacterium before and after the therapy, was categorized into the following five grades: 1) cured; 2) improved; 3) no response; 4) aggravation, and 5) relapse. Results With azithromycin therapy, 14 (27.5%) patients with DPB were completely cured. The symptoms were eliminated to certain degrees for the other 36 cases (70.6%) of DPB. Five-year survival in this cohort was 94.1%. Conclusion Azithromycin is effective and well tolerated for patients with diffuse panbronchiolitis.

Long-term macrolide treatment for chronic respiratory disease

“…Other macrolide antibiotics that have proved effective in DPB include roxithromycin, clarithromycin and azithromycin [17][18][19]. The treatment of DPB is the most striking example of the benefits of using macrolides to treat chronic respiratory diseases, with the 10-year survival rate increasing from 12-50% (depending on whether patients were infected with P. aeruginosa) to .90% since the introduction of macrolide therapy [4,20].…”

Comorbidities in interstitial lung diseases

“…In this scenario, prophylactic antibiotic therapy may have dual benefits: the prevention of infection and added immunomodulation. Azithromycin, an antibiotic with known immunomodulatory properties, first documented in the successful treatment of pan-bronchiolitis, decreases the prevalence of infective exacerbations in bronchiectasis and other chronic lung diseases, and has a beneficial effect on pulmonary fibrosis in a bleomycin lung model [11][12][13][14]. Although no controlled randomised data exists to endorse the routine use of azithromycin in ILDs, it appears logical to consider the prophylactic use of azithromycin in patients experiencing recurrent respiratory infections, with awareness of possible side-effects including reduced hearing acuity and QTc interval prolongation.…”

Diffuse parenchymal lung disease caused by surfactant deficiency: dramatic improvement by azithromycin

“…The effectiveness of macrolides in the treatment of various forms of chronic lung diseases has been discussed in several reports 2 5 6. In addition to their antibacterial effect, there is growing evidence that these molecules also exert beneficial effects through anti-inflammatory actions.…”