Macrolide Antibiotics and Survival in Patients With Acute Lung Injury

Walkey, Allan J.; Wiener, Renda Soylemez

doi:10.1378/chest.11-1908

Cited by 101 publications

(99 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Macrolides have been shown to prevent the production of proinflammatory mediators, cytokines and reactive oxygen species in vitro and in vivo in many studies [19], and they have the effect of controlling exacerbations of underlying respiratory diseases such as asthma, bronchiectasis, panbronchiolitis and cryptogenic organizing pneumonia [20]. Walkey and Wiener [5 ]recently proposed that the anti-inflammatory and immunomodulatory effects of macrolides may benefit patients with acute lung injury. …”

Section: Discussionmentioning

confidence: 99%

“…We selected an azithromycin course length of 5 days on the basis of a previously reported median duration of macrolide use in acute lung injury of 4 days [5]. It is also not known whether macrolides other than azithromycin have similar beneficial effects in AE-CFIP.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, when we encountered a patient with AE-CFIP, we used fluoroquinolone in addition to high-dose steroids. Recently, macrolides have been reported to reduce mortality in acute lung injury [5]. Therefore, the efficacy of intravenous azithromycin, a member of the macrolide class of antibiotics (which inhibit bacterial RNA-directed protein assembly), was prospectively evaluated, and the results were compared with historical data from patients with AE-CFIP who were treated with fluoroquinolone at our institution.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Azithromycin for Treatment of Acute Exacerbation of Chronic Fibrosing Interstitial Pneumonia: A Prospective, Open-Label Study with Historical Controls

et al. 2014

View full text Add to dashboard Cite

Background: Acute exacerbation of chronic fibrosing interstitial pneumonia (AE-CFIP) is an often fatal condition with no established treatment. Recently, macrolides were found to be beneficial in cases of acute lung injury. Objectives: To examine the clinical effectiveness and safety of intravenous azithromycin in patients hospitalized for AE-CFIP. Methods: A prospective, open-label study with historical controls was conducted. Twenty consecutive patients with AE-CFIP received azithromycin. They were compared with a historical cohort treated with fluoroquinolone (n = 56). All patients received high-dose steroid pulse therapy. The primary end point was mortality at 60 days. The secondary end point was safety of intravenous azithromycin in patients with AE-CFIP. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to investigate the relationship between azithromycin use and survival time. Results: Mortality was significantly lower in the patients treated with azithromycin than in those treated with fluoroquinolone (mortality rate at 60 days: 20 vs. 69.6%, p < 0.001; median survival time: not reached vs. 29.5 days, p < 0.001). The IPTW adjusted hazard of mortality at 60 days in patients receiving azithromycin was 0.17 (95% CI 0.05-0.61). No serious adverse events were observed. Conclusions: Azithromycin was associated with improved outcomes in patients with AE-CFIP. Further studies are needed to verify this finding (Clinical trial JMA-IIA00095).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Azithromycin for Treatment of Acute Exacerbation of Chronic Fibrosing Interstitial Pneumonia: A Prospective, Open-Label Study with Historical Controls

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Recently, in a secondary analysis of a large multicentre clinical trial dataset, WALKEY and WIENER [103] evaluated the association between macrolide use and mortality in patients with ALI. Among patients who received a macrolide antibiotic (47 (20%) out of 235), erythromycin was the most common (57%), followed by azithromycin (40%) and clarithromycin (3%).…”

Section: Acute Lung Injurymentioning

confidence: 99%

Long-term macrolide treatment for chronic respiratory disease

2012

View full text Add to dashboard Cite

Long-term macrolide treatment was first shown to alter the natural history of diffuse panbronchiolitis (DPB) in the late 1980s. Since then, macrolides have been demonstrated to exert antiinflammatory and immunomodulatory activity in addition to being antimicrobial. Indeed, their spectrum of action extends to the regulation of leukocyte function and production of inflammatory mediators, control of mucus hypersecretion, resolution of inflammation and modulation of host defence mechanisms. As such, the potential benefit of macrolide antibiotics has been evaluated in a variety of chronic respiratory diseases. The best studied condition is cystic fibrosis, of which there have been six randomised controlled trials showing evidence of benefit. However, most of the studies were limited by small numbers of patients and short follow-up. More recently, landmark studies have demonstrated the efficacy of azithromycin in reducing the risk of acute exacerbations in patients with chronic obstructive pulmonary disease, but the optimal duration and dosing of macrolide treatment remain uncertain.With the exception of patients with DPB and cystic fibrosis, until clear evidence of efficacy is available, the long-term use of macrolides should be limited to highly selected patients after careful evaluation of benefit and harm, or in the context of randomised controlled clinical trials. @ERSpublications Several studies evaluating macrolide antibiotics for the treatment of chronic respiratory diseases are underway

show abstract

“…Of these cephalosporins were used in 39.5%, fluoroquinolones in 38% and macrolides were used in 20% [24].…”

Section: Discussionmentioning

confidence: 99%

Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study

Rao

Chogtu

2015

JCDR

View full text Add to dashboard Cite

Macrolide Antibiotics and Survival in Patients With Acute Lung Injury

Abstract: Background: Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value for patients with acute lung injury (ALI). We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with ALI.

Cited by 101 publications

References 36 publications

Efficacy of Azithromycin for Treatment of Acute Exacerbation of Chronic Fibrosing Interstitial Pneumonia: A Prospective, Open-Label Study with Historical Controls

Efficacy of Azithromycin for Treatment of Acute Exacerbation of Chronic Fibrosing Interstitial Pneumonia: A Prospective, Open-Label Study with Historical Controls

Long-term macrolide treatment for chronic respiratory disease

Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study

Contact Info

Product

Resources

About