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The Impact of Azithromycin on Lung Function in Children And Adolescents with Cystic Fibrosis: A Systematic Review And
Kangping Wu1, Suling Wu1, Lina Wang2
1Department of Pediatric Respiratory Medicine, Hangzhou Children's hospital, Hangzhou, Zhejiang, China.
Insights
Azithromycin may improve lung function (FEV1) and slow decline in children with cystic fibrosis (CF). Further research is needed to confirm long-term benefits and safety.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Medical Research
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting lung function.
- Azithromycin is an antibiotic with known anti-inflammatory properties.
- Current treatment strategies for CF aim to manage symptoms and slow disease progression.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating azithromycin's effect on lung function in pediatric CF patients.
- To assess the impact of azithromycin on forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and lung function decline.
Main Methods:
- Comprehensive electronic searches of major databases (PubMed, Cochrane, Embase, Web of Science, CNKI) were performed.
- Inclusion criteria focused on RCTs in children with CF, using azithromycin versus placebo.
- Random-effects models and heterogeneity assessments (I² statistic) were employed for meta-analysis.
Main Results:
- Eight RCTs with 625 participants were analyzed.
- Azithromycin significantly improved FEV1 (SMD: 0.58, 95% CI: 0.03-1.14) but not FVC (SMD: 0.62, 95% CI: -0.04 to 1.29).
- A reduced risk of lung function decline was observed (RR: 0.79, 95% CI: 0.62-1.00), with substantial heterogeneity noted in FEV1 and FVC analyses.
Conclusions:
- Azithromycin demonstrates potential for improving FEV1 and mitigating lung function decline in pediatric CF.
- Its anti-inflammatory and immunomodulatory effects are likely mechanisms of action.
- Further large-scale studies are recommended to confirm long-term efficacy, safety, and optimal treatment protocols.
Purpose:
This study aims to evaluate the effects of azithromycin on lung function in children with cystic fibrosis (CF) through a systematic review and meta-analysis of randomized controlled trials (RCTs). The study primarily focuses on its impact on FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and the progression of lung function decline.
Methods:
Electronic searches were conducted across PubMed,Cochrane Central, Embase, Web of Science, and China National Knowledge Infrastructure databases, including studies published up to November 1, 2024. Inclusion criteria required RCTs involving children with CF, azithromycin as the intervention, and placebo controls. Meta-analyses were performed using random-effects models, and heterogeneity was assessed using the I² statistic. Sensitivity analyses were conducted to ensure the robustness of results.
Findings:
Eight RCTs were included, covering a total of 625 participants. Meta-analysis revealed that azithromycin significantly improved FEV1 compared to the control group, with a standardized mean difference (SMD) of 0.58 (95% CI: 0.03-1.14), though substantial heterogeneity was observed (I² = 82.8%). However, no statistically significant improvement in FVC was detected (SMD: 0.62, 95% CI: -0.04 to 1.29, I² = 85.4%). Additionally, azithromycin reduced the relative risk of lung function decline (RR: 0.79, 95% CI: 0.62-1.00), with moderate heterogeneity (I² = 45.5%). Sensitivity analyses confirmed the stability of these results.
Implications:
Azithromycin shows potential in improving FEV1 and slowing lung function decline in children with cystic fibrosis, likely through its anti-inflammatory and immunomodulatory effects. Further large-scale studies are warranted to confirm its long-term efficacy, evaluate safety, and optimize treatment strategies, including potential combination therapies.
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