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Drug Reduces Exacerbations in Obstructive Pulmonary Disease

Erythromycin reduces exacerbation frequency and duration

MONDAY, Nov. 24 (HealthDay News) -- The antibiotic erythromycin is more effective than a placebo in reducing the frequency and duration of exacerbations in patients with chronic obstructive pulmonary disease (COPD), according to study findings published in the Dec. 1 issue of the American Journal of Respiratory and Critical Care Medicine.

Terence A.R. Seemungal, Ph.D., and colleagues from University College London in the United Kingdom randomly assigned 109 patients with COPD to placebo or 250 mg erythromycin twice a day for 12 months. Macrolide antibiotics have airway anti-inflammatory activity and may reduce exacerbation frequency, they note.

The researchers observed 206 moderate to severe exacerbations, of which 125 occurred in the placebo arm. Exacerbations occurred at a significantly lower rate (rate ratio 0.648) and with shorter duration (median, nine versus 13 days) in the erythromycin patients. The median time to first exacerbation was significantly longer in the erythromycin group (271 versus 89 days). The two groups were similar in terms of various cytokines, forced expiratory volume in one second, myeloperoxidase, bacterial flora, and serum C-reactive protein.

"From a societal standpoint, there are other important implications to chronic antimicrobial therapy in patients with COPD, particularly with regards to emergence of bacterial resistance," Ken M. Kunisaki, M.D., and Dennis E. Niewoehner, M.D., from the University of Minnesota in Minneapolis, write in an accompanying editorial. "Balancing benefit against harm could pose a dilemma for which there might be no clear answers."

Niewoehner has a financial relationship with the pharmaceutical industry.

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