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Irish Journal of Medical Science (1971 -)

, Volume 185, Issue 4, pp 993–997 | Cite as

Assessing potential risks of treatment with long-term azithromycin in COPD patients: long-term oxygen users beware?

  • T. T. Nicholson
  • A. Franciosi
  • S. Landers
  • M. W. Butler
Brief Report

Abstract

Introduction

Long-term daily azithromycin therapy reduces the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) in a randomized controlled clinical trial setting. Concerns exist regarding arrhythmic and auditory toxicities from chronic use in the real-world setting. We hypothesized that risk factors for adverse drug reactions to azithromycin would be more frequent than previously reported, that certain specific subgroups would have different frequencies of these risk factors and that the whispered voice test would be a useful test with which to test for hearing deficits.

Methods

Following ethical approval, 47 consecutive hospital-based patients with a mean age 69 years ± 8.2, and with physician-diagnosed COPD (mean FEV1 45.1 ± 18 % predicted), were screened for subjective hearing impairment (screening questions and whispered voice test) and by electrocardiogram for prolonged QTc. Other potential risk factors and contraindications to long-term daily azithromycin were sought.

Results

In total, 38 patients (80.9 %) had at least one risk factor or contraindication to azithromycin treatment. 19 patients (40.4 % of total) had subjective hearing impairment. 17 (36.1 %) had prolonged QTc intervals. 4 patients (8.51 %) had contraindicating co-morbidities. Those on long-term oxygen therapy were significantly more likely to have at least one risk factors or contraindications to azithromycin (p = 0.0025).

Conclusion

In a COPD population who would otherwise potentially be candidates for long-term daily azithromycin therapy, over 80 % had risk factors for complications from long-term daily azithromycin. Preventative treatment with long-term daily azithromycin may be appropriate for fewer COPD patients than previously thought, especially in those on long-term oxygen therapy.

Keywords

Azithromycin maintenance Chronic obstructive pulmonary disease Complications Hearing loss Screening 

Notes

Compliance with ethical standards

Funding

This study did not receive any funding.

Conflict of interest

Dr. Trevor Nicholson, Dr. Alessandro Franciosi, Dr. Sarah Landers, and Dr. Marcus Butler declare they have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at St. Vincent’s University Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Hon AJ, Bach JR (2010) Chronic respiratory care for neuromuscular diseases in adults. Eur Respir J 35(5):1192. doi: 10.1183/09031936.00200709 (author reply-3; Epub 2010/05/04)
  2. 2.
    Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JAD, Criner GJ, Curtis JL, Dransfield MT, Han MK, Lazarus SC, Make B, Marchetti N, Martinez FJ, Madinger NE, McEvoy C, Niewoehner DE, Porsasz J, Price CS, Reilly J, Scanlon PD, Sciurba FC, Scharf SM, Washko GR, Woodruff PG, Anthonisen NR (2011) Azithromycin for prevention of exacerbations of COPD. N Engl J Med 365(8):689–698CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Uzun S, Djamin RS, Kluytmans JA, Mulder PG, van’t Veer NE, Ermens AA, Pelle AJ, Hoogsteden HC, Aerts JG, van der Eerden MM (2014) Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2(5):361–368. doi: 10.1016/s2213-2600(14)70019-0 [Epub 2014/04/22]
  4. 4.
    Simoens S, Laekeman G, Decramer M (2013) Preventing COPD exacerbations with macrolides: a review and budget impact analysis. Respir Med 107(5):637–648. doi: 10.1016/j.rmed.2012.12.019 [Epub 2013/01/29]
  5. 5.
    Albert RK, Connett J, Criner GL, Han M (2014) Azithromycin: we’re there! Am J Respir Crit Care Med 190(9):1074–1075. doi: 10.1164/rccm.201408-1436LE [Epub 2014/11/02]
  6. 6.
    Wolter J, Seeney S, Bell S, Bowler S, Masel P, McCormack J (2002) Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial. Thorax 57(3):212–216 [Epub 2002/02/28] Google Scholar
  7. 7.
    Haworth CS, Bilton D, Elborn JS (2014) Long-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and questions. Respir Med 108(10):1397–1408. doi: 10.1016/j.rmed.2014.09.005 [Epub 2014/10/11]
  8. 8.
    Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM (2012) Azithromycin and the risk of cardiovascular death. N Engl J Med 366(20):1881–1890CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Svanstrom H, Pasternak B, Hviid A (2013) Use of azithromycin and death from cardiovascular causes. N Engl J Med 368(18):1704–1712CrossRefPubMedGoogle Scholar
  10. 10.
    Albert RK, Schuller JL (2014) Macrolide antibiotics and the risk of cardiac arrhythmias. Am J Respir Crit Care Med 189(10):1173–1180. doi: 10.1164/rccm.201402-0385CI [Epub 2014/04/09]
  11. 11.
    Restrepo MI, Anzueto A (2014) Macrolide antibiotics for prevention of chronic obstructive pulmonary disease exacerbations: are we there yet? Am J Respir Crit Care Med 190(1):1–2. doi: 10.1164/rccm.201406-1014ED [Epub 2014/07/02]
  12. 12.
    Serisier DJ (2013) Risks of population antimicrobial resistance associated with chronic macrolide use for inflammatory airway diseases. Lancet Respir Med 1(3):262–274. doi: 10.1016/s2213-2600(13)70038-70039 [Epub 2014/01/17]
  13. 13.
    Bagai A, Thavendiranathan P, Detsky AS (2006) Does this patient have hearing impairment? JAMA 295(4):416–428CrossRefPubMedGoogle Scholar
  14. 14.
    Pirozzo S, Papinczak T, Glasziou P (2003) Whispered voice test for screening for hearing impairment in adults and children: systematic review. BMJ 327(7421):967Google Scholar
  15. 15.
    Yap YG, Camm AJ (2003) Drug induced QT prolongation and torsades de pointes. Heart 89(11):1363–1372 (PubMed PMID: PMC1767957 ) Google Scholar
  16. 16.
    Justo D, Zeltser D (2006) Torsades de pointes induced by antibiotics. Eur J Int Med 17(4):254–259. doi:  10.1016/j.ejim.2005.12.003 [Epub 2006/06/10]
  17. 17.
    Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, Decramer M (2008) A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 359(15):1543–1554. doi: 10.1056/NEJMoa0805800 [Epub 2008/10/07]
  18. 18.
    Wang J, Nie B, Xiong W, Xu Y (2012) Effect of long-acting beta-agonists on the frequency of COPD exacerbations: a meta-analysis. J Clin Pharm Therap 37(2):204–11. doi: 10.1111/j.1365-2710.2011.01285.x [Epub 2011/07/12]
  19. 19.
    Kardos P, Wencker M, Glaab T, Vogelmeier C (2007) Impact of salmeterol/fluticasone propionate versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 175(2):144–9. doi:  10.1164/rccm.200602-244OC [Epub 2006/10/21]

Copyright information

© Royal Academy of Medicine in Ireland 2015

Authors and Affiliations

  • T. T. Nicholson
    • 1
  • A. Franciosi
    • 1
  • S. Landers
    • 1
  • M. W. Butler
    • 1
  1. 1.Department of Respiratory MedicineSt. Vincent’s University Hospital and University College DublinDublin 4Ireland

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