A retrospective study comparing the effects of different antibiotics in preventing bronchiectasis exacerbations demonstrated the superior effectiveness of azithromycin, compared to other antibiotics from the same class, including erythromycin and roxithromycin.
The Chinese study, “Azithromycin or erythromycin? Macrolides for non-cystic fibrosis bronchiectasis in adults: a systematic review and adjusted indirect treatment comparison,” was published in the Chronic Respiratory Disease journal.
Between 2000 and 2007, bronchiectasis morbidity in the U.S. was 1,106 cases per 100,000 people, with an annual increase of 8.74 percent.
A number of treatments are prescribed to manage the disease, including antibiotics. These are used to prevent the worsening of symptoms, or exacerbation, and to reduce the number of bacteria in the lungs.
This is the case of macrolides, a class of antibiotics that are not only antibacterial but also have immune-regulatory effects. Azithromycin, erythromycin, and roxithromycin belong to the macrolides group and are sold under several brand names.
Due to the broad range of macrolides, physicians pose the question, “Which kind of macrolide antibiotic is more effective and safe in preventing bronchiectasis exacerbation?”
To find the answer, a research team from Guiyang University of Chinese Medicine in Guiyang, China, studied clinical trials published until May 2017 that reported the use of macrolides in patients with non-cystic fibrosis bronchiectasis, and compared the results in terms of safety and efficacy.
The team analyzed data collected from seven studies enrolling 457 participants.
Researchers found that macrolides, in general, decreased the rate and number of bronchiectasis exacerbations, measured as the number of exacerbations per patient and per year, respectively.
A more detailed analysis revealed that azithromycin and erythromycin, but not roxithromycin, significantly decreased the number of disease exacerbations. Azithromycin was actually more effective as it induced a significantly lower exacerbation rate than erythromycin, demonstrating the superior effectiveness of the drug in preventing exacerbations.
Diarrhea, nausea, and other gastrointestinal reactions are known common adverse events of macrolides. Azithromycin increased the risk of diarrhea and abnormal pain, compared to placebo treatments and other macrolides.
Overall, the study demonstrated azithromycin’s superior capacity to decrease bronchiectasis exacerbations, and can eventually help physicians deciding which antibiotic to prescribe.
“This meta-analysis suggested that long-term treatment with macrolides significantly reduced the incidence of non-cystic fibrosis (CF) bronchiectasis exacerbation,” the researchers wrote, adding that “indirect treatment comparisons showed that azithromycin is more efficient than roxithromycin and erythromycin in preventing non-CF from exacerbation.”