Prophylactic azithromycin may reduce hospital stays and the need for rescue antibiotics in patients with idiopathic pulmonary fibrosis (IPF), according to a retrospective study published in the European Respiratory Journal.

Researchers analyzed the use of prophylactic macrolides (azithromycin 250 mg 3 times per week) in patients with IPF to evaluate the effect the medication has on hospital admission, disease progression, need for rescue antibiotics, tolerability, and side effects.

Of the 108 patients with IPF, 61% were men, the mean age was 68.3±10.9 years, the mean diffusing capacity of the lungs for carbon monoxide (DLCO) score was 33.2%±13.8%, the mean forced vital capacity percent predicted was 70.0%±20.0%, and the mean survival was 29 months. 

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A total of 93% of patients tolerated the medication with 8 discontinuing due to adverse effects (tinnitus: n=1, gastrointestinal intolerance: n=7). Patients prescribed prophylactic azithromycin were younger (odds ratio [OR]= –0.96, P =.006), had a lower DLCO (OR=–0.91, P =.01), and had more previous antibiotic prescriptions (OR= 3.2, P =1.77e-06) than patients who were not prescribed azithromycin.

In the entire cohort, the number of hospital admissions dropped from 31 the year before to 7 while participants took prophylactic azithromycin, and the number of antibiotics prescribed dropped from 176 courses the year before to 40 while participants took prophylactic azithromycin. In the entire cohort, the median DLCO was –7.4% the year before and –8.4% while on prophylactic azithromycin, and the forced vital capacity was –4.6% the year before and –2.5% while on prophylactic azithromycin.

Future studies need to differentiate between the antibacterial properties and the anti-inflammatory activity of the macrolide, classify the reason for the hospital admission, and include microbiological sampling analysis.

The researchers concluded, “The introduction of prophylactic antibiotics was well tolerated, associated with minimal side effects and reduced the unplanned hospitalization rate by over two thirds in this cohort.”

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Macaluso C, Furcada JM, Alzaher O, et al. The potential impact of azithromycin in idiopathic pulmonary fibrosis [published online November 15, 2018]. Eur Respir J. doi:10.1183/13993003.00628-2018