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Erythromycin to prevent exacerbations of bronchiectasis
  1. Shea McNeill
  1. Correspondence to Dr Shea McNeill, Department of Respiratory Medicine, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, Northern Ireland; smcneill06{at}qub.ac.uk

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The purpose of this study was to evaluate whether low-dose erythromycin would reduce pulmonary exacerbations in patients with non-cystic fibrosis (CF) brocnchiectasis with a history of frequent exacerbations. In comparison to previously published work using azithromycin prophylaxis, a prolonged period of 12 months was used for evaluation and there were attempts to more precisely quantify the bacterial resistance associated with prolonged macrolide use.

In this randomised, double-blind, placebo-controlled trial, 679 patients were screened with 117 randomised after the exclusion criteria were applied. A total of 107 completed the study. Reasons for exclusion included no high-resolution CT confirmed bronchiectasis and insufficient pre-trial exacerbations. Fifty-nine individuals were randomised to the erythromycin group (oral erythromycin ethylsuccinate 400 mg twice daily) and 58 to the placebo group.

There was a significant reduction in ‘protocol defined pulmonary exacerbations’ in the erythromycin group. In the pre-specified subgroup of patients with baseline Pseudomonas aeruginosa airway infection, again there was significant improvement. There was an increase in the proportion of macrolide-resistant oropharyngeal streptococci in the erythromycin group.

Long-term, low-dose erythromycin appears effective in reducing pulmonary exacerbations in non-CF bronchiectasis. There is evidence that it may also protect against lung function decline and contribute to a reduction in sputum production. Of concern is the significant increase in macrolide oropharyngeal streptococci resistance. For this reason, it may be advisable for a larger, multicentre population study of longer duration to be carried out prior to any widespread application in clinical practice. A study comparing erythromycin, azithromycin and placebo using similar outcome measures would be of interest.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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