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(Ivanhoe Newswire) -- Long-term use of an antibiotic may reduce the frequency of exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD), but the threat of growing antibiotic resistance may affect those encouraging results.
In the first study of its kind, researchers followed 109 patients with moderate to severe COPD for a year after randomly assigning them to receive either a placebo or a twice daily 250 mg dose of erythromycin. The patients recorded their exacerbations and hospitalizations in a daily diary card, and they were assessed using spirometry, sputum testing and blood testing for lung function, bacterial infection and markers of inflammation.
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The patients who took erythromycin had fewer exacerbations, and 60 percent of the exacerbations that occurred were within the placebo group, researchers found. Also, more than twice as many hospitalizations occurred among the placebo group, and the median duration of hospital stays was nine days in the erythromycin group and 13 days in the placebo group.
Even though the researchers findings are encouraging, they caution the widespread prophylactic use of erythromycin could lead increased antibiotic resistance.
However, John Heffner, M.D., the past president of the American Thoracic Society pointed out that each year, exacerbations in COPD patients account for more than $30 billion in direct and indirect costs in the U.S. alone.
The relative risks of breeding resistance with a long-term preventative use of erythromycin versus more frequent short-term dosing of highly potent antibiotics for acute exacerbations require careful analysis. If future studies demonstrate similar efficacy of prolonged erythromycin therapy, especially if patients are already receiving inhaled steroids and long-acting bronchodilators, the benefits likely will outweigh the risks, Heffner was quoted as saying.
SOURCE: American Journal of Respiratory and Critical Care Medicine, December 2008
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