Long-term, low-dose erythromycin in bronchiectasis subjects with frequent infective exacerbations

Area of Science:

• Pulmonology
• Infectious Diseases
• Pharmacology

Background:

• Macrolide antibiotics are increasingly used for non-cystic fibrosis (CF) bronchiectasis.
• The widespread use of macrolides like azithromycin raises concerns about antimicrobial resistance.
• Efficacy in CF patients has led to empiric use in non-CF bronchiectasis.

Purpose of the Study:

• To evaluate the impact of long-term, low-dose oral erythromycin on pulmonary exacerbation frequency in non-CF bronchiectasis.
• To gather data to power a definitive randomized-controlled trial (RCT).

Main Methods:

• An uncontrolled evaluation of 24 adult non-CF bronchiectasis subjects with at least two exacerbations in the prior year.
• Subjects received prophylactic oral erythromycin 250 mg daily for 12 months.
• Co-primary outcomes: number of infective exacerbations and antibiotic days for exacerbations, compared pre- and post-treatment.

Main Results:

• Erythromycin therapy halved the median annual number of infective exacerbations (2 vs. 4, p < 0.0001).
• Annual antibiotic use days were also halved (21 vs. 44, p < 0.0001).
• Results were significant in 24 evaluable subjects completing 12 months of therapy.

Conclusions:

• Low-dose erythromycin demonstrates a robust effect on exacerbation frequency in non-CF bronchiectasis.
• These findings support proceeding to a definitive intervention study (RCT).
• An RCT is underway, incorporating bronchoscopic evaluation for pathophysiologic data.