Effects of prolonged use of azithromycin in patients with cystic fibrosis: A meta-analysis

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Abstract

Azithromycin has been studied as potential therapeutic anti-inflammatory agent for cystic fibrosis (CF) patients. Azithromycin (AZM) has been used as an immunomodulating agent, based on few small studies. Considering the cost and potential side effects of long-term azithromycin therapy, it is important to identify the group of patients that would benefit the most. Weighted mean difference was used for pulmonary function tests, and risk ratios for all other variables. The random-effects model was applied for all reports. Combining four studies (N = 368), azithromycin showed increase in FEV1 (3.53%, 95% CI 0.00, 7.07, p = 0.05; I2 = 38%) and FVC (4.24%, 95% CI 2.02, 6.45, p = 0.0002; I2 = 0%). When trials were analyzed by baseline Pseudomonas sputum colonization, the heterogeneity decreased (I2 = 0%), FEV1 significantly increased to 4.66% (95% CI 1.18, 8.15, p = 0.009), and FVC increased to 4.64% (95% CI 2.11, 7.17, p = 0.0003). The GI side effects were 72% higher with azithromycin use (RR 1.72, 95% CI 1.33, 2.21, p = 0.00003), the main side effects being nausea (RR 2.04, 95% CI 1.19, 3.45, p = 0.009), and diarrhea (RR 2.12, 95% CI 1.10, 4.08, p = 0.02). Azithromycin improves lung function of CF patients, especially in the subgroup colonized with Pseudomonas. However, nausea and diarrhea are significantly more frequent with azythromycin.

Original languageEnglish (US)
Pages (from-to)467-472
Number of pages6
JournalPulmonary Pharmacology and Therapeutics
Volume22
Issue number6
DOIs
StatePublished - Dec 1 2009

Fingerprint

Azithromycin
Cystic Fibrosis
Meta-Analysis
Pseudomonas
Nausea
Diarrhea
Respiratory Function Tests
Sputum
Anti-Inflammatory Agents
Odds Ratio
Costs and Cost Analysis
Lung
Therapeutics
Costs

Keywords

  • Azithromycin
  • Cystic fibrosis
  • FEV
  • FVC
  • Pseudomonas

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Biochemistry, medical
  • Pharmacology (medical)

Cite this

@article{c30778f195f34522acff8414edca4963,
title = "Effects of prolonged use of azithromycin in patients with cystic fibrosis: A meta-analysis",
abstract = "Azithromycin has been studied as potential therapeutic anti-inflammatory agent for cystic fibrosis (CF) patients. Azithromycin (AZM) has been used as an immunomodulating agent, based on few small studies. Considering the cost and potential side effects of long-term azithromycin therapy, it is important to identify the group of patients that would benefit the most. Weighted mean difference was used for pulmonary function tests, and risk ratios for all other variables. The random-effects model was applied for all reports. Combining four studies (N = 368), azithromycin showed increase in FEV1 (3.53{\%}, 95{\%} CI 0.00, 7.07, p = 0.05; I2 = 38{\%}) and FVC (4.24{\%}, 95{\%} CI 2.02, 6.45, p = 0.0002; I2 = 0{\%}). When trials were analyzed by baseline Pseudomonas sputum colonization, the heterogeneity decreased (I2 = 0{\%}), FEV1 significantly increased to 4.66{\%} (95{\%} CI 1.18, 8.15, p = 0.009), and FVC increased to 4.64{\%} (95{\%} CI 2.11, 7.17, p = 0.0003). The GI side effects were 72{\%} higher with azithromycin use (RR 1.72, 95{\%} CI 1.33, 2.21, p = 0.00003), the main side effects being nausea (RR 2.04, 95{\%} CI 1.19, 3.45, p = 0.009), and diarrhea (RR 2.12, 95{\%} CI 1.10, 4.08, p = 0.02). Azithromycin improves lung function of CF patients, especially in the subgroup colonized with Pseudomonas. However, nausea and diarrhea are significantly more frequent with azythromycin.",
keywords = "Azithromycin, Cystic fibrosis, FEV, FVC, Pseudomonas",
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AU - Murphy, Peter J

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N2 - Azithromycin has been studied as potential therapeutic anti-inflammatory agent for cystic fibrosis (CF) patients. Azithromycin (AZM) has been used as an immunomodulating agent, based on few small studies. Considering the cost and potential side effects of long-term azithromycin therapy, it is important to identify the group of patients that would benefit the most. Weighted mean difference was used for pulmonary function tests, and risk ratios for all other variables. The random-effects model was applied for all reports. Combining four studies (N = 368), azithromycin showed increase in FEV1 (3.53%, 95% CI 0.00, 7.07, p = 0.05; I2 = 38%) and FVC (4.24%, 95% CI 2.02, 6.45, p = 0.0002; I2 = 0%). When trials were analyzed by baseline Pseudomonas sputum colonization, the heterogeneity decreased (I2 = 0%), FEV1 significantly increased to 4.66% (95% CI 1.18, 8.15, p = 0.009), and FVC increased to 4.64% (95% CI 2.11, 7.17, p = 0.0003). The GI side effects were 72% higher with azithromycin use (RR 1.72, 95% CI 1.33, 2.21, p = 0.00003), the main side effects being nausea (RR 2.04, 95% CI 1.19, 3.45, p = 0.009), and diarrhea (RR 2.12, 95% CI 1.10, 4.08, p = 0.02). Azithromycin improves lung function of CF patients, especially in the subgroup colonized with Pseudomonas. However, nausea and diarrhea are significantly more frequent with azythromycin.

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