Azithromycin for Prevention of Exacerbations of COPD
New England Journal of Medicine,  Clinical Article

Albert RK et al. - Among selected subjects with chronic obstructive pulmonary disease (COPD), azithromycin taken daily for 1 year, when added to usual treatment, decreased the frequency of exacerbations and improved quality of life but caused hearing decrements in a small percentage of subjects. Although this intervention could change microbial resistance patterns, the effect of this change is not known.

Methods
  • The authors performed a randomized trial to determine whether azithromycin decreased the frequency of exacerbations in participants with COPD who had an increased risk of exacerbations but no hearing impairment, resting tachycardia, or apparent risk of prolongation of the corrected QT interval.
  • A total of 1577 subjects were screened; 1142 (72%) were randomly assigned to receive azithromycin, at a dose of 250 mg daily (570 participants), or placebo (572 participants) for 1 year in addition to their usual care.

Results
  • The rate of 1-year follow-up was 89% in the azithromycin group and 90% in the placebo group.
  • The median time to the first exacerbation was 266 days (95% confidence interval [CI], 227 to 313) among participants receiving azithromycin, as compared with 174 days (95% CI, 143 to 215) among participants receiving placebo (P<0.001).
  • The frequency of exacerbations was 1.48 exacerbations per patient-year in the azithromycin group, as compared with 1.83 per patient-year in the placebo group (P=0.01), and the hazard ratio for having an acute exacerbation of COPD per patient-year in the azithromycin group was 0.73 (95% CI, 0.63 to 0.84; P<0.001).
  • The scores on the St. George's Respiratory Questionnaire (on a scale of 0 to 100, with lower scores indicating better functioning) improved more in the azithromycin group than in the placebo group (a mean [±SD] decrease of 2.8±12.8 vs. 0.6±11.4, P=0.004); the percentage of participants with more than the minimal clinically important difference of -4 units was 43% in the azithromycin group, as compared with 36% in the placebo group (P=0.03).
  • Hearing decrements were more common in the azithromycin group than in the placebo group (25% vs. 20%, P=0.04).

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...

Your Unread Messages in Physician Assistant

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Physician Assistant Articles

1 Dance for Parkinson's: A new framework for research on its physical, mental, emotional, and social benefits Complementary Therapies in Medicine, June 17, 2014    Review Article

2 Statins in the elderly: an answered question Current Opinion in Cardiology, June 9, 2014    Evidence Based Medicine    Review Article    Clinical Article

3 Efficacy of high-dose versus standard-dose influenza vaccine in older adults New England Journal of Medicine, August 15, 2014    Evidence Based Medicine    Clinical Article

4 Hepatitis a hospitalizations in the United States, 2002 – 2011 Hepatology, October 3, 2014    Clinical Article

5 A statin a day to keep the doctor away? comparing aspirin and statins for primary prevention of cardiovascular disease Annals of Pharmacotherapy, August 7, 2014    Clinical Article

6 Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States BMJ, June 24, 2014    Evidence Based Medicine    Clinical Article

7 Consumption of nuts and legumes and risk of stroke: a meta-analysis of prospective cohort studies Nutrition, Metabolism & Cardiovascular Diseases, July 25, 2014    Evidence Based Medicine    Clinical Article

8 Hemoglobin A1c levels and risk of severe hypoglycemia in children and young adults with type 1 diabetes from Germany and Austria: a trend analysis in a cohort of 37,539 patients between 1995 and 2012 Full Text PLoS Medicine, October 10, 2014    Free full text    Evidence Based Medicine    Clinical Article

9 Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial JAMA, October 10, 2014    Evidence Based Medicine    Clinical Article

10 The effectiveness of metoprolol versus atenolol on prevention of all-cause and cardiovascular mortality in a large Chinese population: A cohort study International Journal of Cardiology, June 27, 2014    Clinical Article

11 Vitamin E and C supplementation and risk of cancer in men: posttrial follow-up in the Physicians’ Health Study II randomized trial American Journal of Clinical Nutrition, July 10, 2014    Clinical Article

12 The effect of indapamide versus hydrochlorothiazide on ventricular and arterial function in patients with hypertension and diabetes: Results of a randomized trial American Heart Journal, October 3, 2014    Clinical Article

13 Meta-analysis of non-steroidal anti-inflammatory drug use and risk of atrial fibrillation The American Journal of Cardiology, October 3, 2014    Evidence Based Medicine    Review Article    Clinical Article

14 Switching from allopurinol to febuxostat for the treatment of hyperuricemia and renal function in patients with chronic kidney disease Clinical Rheumatology, October 10, 2014    Clinical Article

15 Calcium channel blocker compared with angiotensin receptor blocker for patients with hypertension: a meta-analysis of randomized controlled trials The Journal of Clinical Hypertension, August 13, 2014    Evidence Based Medicine    Review Article    Clinical Article

16 Cardiac dysfunction associated with a nucleotide polymerase inhibitor for treatment of hepatitis C Hepatology, October 3, 2014    Clinical Article

17 Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children The Journal of Allergy and Clinical Immunology, October 10, 2014    Clinical Article

18 The management of cirrhosis in women Alimentary Pharmacology and Therapeutics, October 10, 2014    Review Article

19 Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12 Journal of Clinical Oncology, October 17, 2014    Clinical Article

20 Management of high-grade gliomas in the elderly Seminars in Radiation Oncology, October 3, 2014    Clinical Article

Indexed Journals in Physician Assistant: Advance for Physicians Assistants, American Family Physicianmore