Can azithromycin prophylaxis reduce respiratory exacerbations in patients with primary antibody deficiencies?

Published online: March 22, 2019

In a host with antibody deficiency, the respiratory tract is a major target for infections, requiring immunoglobulin replacement therapy and frequent courses of antibiotics. Over time, these patients might develop chronic infection-related pulmonary diseases, including bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. As shown in chronic lung diseases, such as cystic fibrosis, immunodeficiency patients might benefit from using antibiotic prophylaxis with azithromycin to reduce respiratory complications.

In a paper recently published in The Journal of Allergy and Clinical Immunology (JACI), Milito and colleagues describe a 36-month phase II, randomized, double-blind, multi-center clinical trial conducted to test the hypothesis that prophylactic treatment with low-dose azithromycin (250 mg once daily, three times a week, for three consecutive days) decrease the frequency of respiratory exacerbations in patients with primary antibody deficiencies, who have developed chronic lung disease.

Compared to patients who received placebo, patients who received prophylaxis with azithromycin had a reduced frequency of respiratory exacerbations, a reduction in use of antibiotics, a reduced risk of hospitalization, improved quality of life, a similar rate of macrolide-resistant organisms, and a similar rate of adverse events.

This study demonstrated the efficacy and safety of using azithromycin to reduce respiratory complications in patients with antibody deficiencies.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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