How does azithromycin affect cough symptoms in chronic respiratory diseases. What is the efficacy of azithromycin for treating chronic wet cough. Is azithromycin safe for patients with chronic respiratory diseases and cough. What does research show about azithromycin prescribing practices for chronic cough.

Understanding Azithromycin’s Role in Treating Chronic Respiratory Diseases

Azithromycin, a macrolide antibiotic, has garnered attention for its potential in managing chronic respiratory diseases, particularly those associated with persistent cough. Beyond its well-known antibacterial properties, azithromycin has demonstrated anti-inflammatory and immunomodulatory effects that may benefit patients with conditions such as bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma.

Chronic cough affects a significant portion of the adult population, with 8-10% seeking medical care for this symptom in both Western countries and China. The underlying causes of chronic cough are diverse, including asthma, eosinophilic bronchitis, postnasal drip syndrome, rhinosinusitis, COPD, and bronchiectasis.

Traditional Treatments for Chronic Respiratory Diseases

Conventional treatments for chronic respiratory diseases with cough have typically included:

• Inhaled corticosteroids (ICS)
• β2 adrenergic receptor agonists
• Muscarinic receptor antagonists
• Phosphodiesterase inhibitors
• Leukotriene receptor antagonists
• N-acetylcysteine
• Immunotherapy (monoclonal antibodies)

However, these treatments often show limited efficacy in cases of refractory cough, highlighting the need for alternative approaches.

Azithromycin’s Mechanism of Action in Respiratory Diseases

How does azithromycin work beyond its antibacterial effects? Azithromycin exhibits anti-inflammatory and immunomodulatory properties that may prove beneficial in managing chronic airway inflammatory diseases. These additional effects have sparked interest in its use for conditions like bronchiectasis, COPD, and asthma.

Anti-inflammatory and Immunomodulatory Effects

The anti-inflammatory and immunomodulatory actions of azithromycin include:

1. Reduction of pro-inflammatory cytokines
2. Modulation of neutrophil function
3. Alteration of macrophage phenotype
4. Enhancement of airway epithelial cell function

These mechanisms may contribute to the potential benefits of azithromycin in managing chronic respiratory diseases and associated cough symptoms.

Efficacy of Azithromycin in Treating Chronic Cough

Does azithromycin effectively reduce cough symptoms in patients with chronic respiratory diseases? A systematic review and meta-analysis of randomized controlled trials (RCTs) provides insights into this question.

Meta-analysis Findings

The meta-analysis included 5 RCTs with a total of 879 patients. Initially, the results showed no significant effect of azithromycin in reducing cough compared to placebo [mean difference (MD) 0.73; 95% CI: −0.78 to 2.24; P=0.34]. However, there was significant heterogeneity among the studies (P=0.03, I2=71%).

Upon further analysis, it was found that the heterogeneity was primarily caused by one study. After removing this outlier, the results painted a different picture:

• Azithromycin administration showed a clinically important improvement in Leicester Cough Questionnaire (LCQ) score (MD 1.30; 95% CI: 1.15–1.46; P<0.00001; I2=0%)

This finding suggests that azithromycin may indeed offer significant benefits for chronic respiratory diseases related to cough when accounting for study heterogeneity.

Safety Profile of Azithromycin in Chronic Respiratory Diseases

Is azithromycin safe for patients with chronic respiratory diseases and cough? The meta-analysis also examined the safety profile of azithromycin in this patient population.

Adverse Events and Side Effects

The analysis revealed:

• No significant difference in overall adverse events between azithromycin and placebo groups
• Azithromycin administration was associated with fewer central nervous system side effects in patients with chronic respiratory diseases and cough

These findings suggest that azithromycin is generally well-tolerated in this patient population, with a potentially favorable side effect profile regarding central nervous system effects.

Azithromycin Prescribing Practices for Chronic Wet Cough

How do respiratory pediatricians in Australia and New Zealand approach azithromycin prescribing for chronic wet cough? A questionnaire-based survey provides insights into current clinical practices.

Survey Findings

While specific details of the survey are not provided in the original text, it is important to note that such surveys can offer valuable information on:

• Frequency of azithromycin prescribing for chronic wet cough
• Dosing regimens and duration of treatment
• Factors influencing prescribing decisions
• Perceived efficacy and safety concerns

Understanding these prescribing patterns can help inform clinical guidelines and identify areas for further research and education.

Implications for Clinical Practice

What are the potential implications of these findings for the management of chronic respiratory diseases with cough? The meta-analysis results suggest that azithromycin may offer a valuable addition to the treatment armamentarium for these conditions.

Considerations for Azithromycin Use

When considering azithromycin as a treatment option, clinicians should take into account:

• The specific respiratory condition and its underlying cause
• The severity and duration of cough symptoms
• The patient’s response to conventional treatments
• Potential drug interactions and contraindications
• The risk of antimicrobial resistance with long-term use

Individualizing treatment decisions based on these factors can help optimize outcomes for patients with chronic respiratory diseases and persistent cough.

Future Research Directions

While the current evidence suggests potential benefits of azithromycin in treating chronic respiratory diseases with cough, further research is needed to fully elucidate its role and optimize its use.

Areas for Future Study

Future research efforts should focus on:

1. Larger, well-designed RCTs to confirm the efficacy of azithromycin across different respiratory conditions
2. Identification of specific patient subgroups most likely to benefit from azithromycin treatment
3. Optimal dosing regimens and duration of therapy for different indications
4. Long-term safety and effects on antimicrobial resistance with prolonged use
5. Comparison of azithromycin with other macrolides or alternative treatments
6. Mechanisms underlying the anti-inflammatory and immunomodulatory effects in respiratory diseases

These research directions will help refine clinical guidelines and improve patient outcomes in the management of chronic respiratory diseases with cough.

Azithromycin in the Context of Antimicrobial Stewardship

How does the use of azithromycin for chronic respiratory diseases align with principles of antimicrobial stewardship? This is an important consideration given the global concern over antimicrobial resistance.

Balancing Benefits and Risks

When prescribing azithromycin for non-infectious indications such as chronic cough, healthcare providers must carefully weigh the potential benefits against the risks of promoting antimicrobial resistance. Strategies to promote responsible use include:

• Reserving azithromycin for cases where conventional treatments have failed
• Using the lowest effective dose and shortest duration of treatment
• Monitoring for clinical improvement and discontinuing if no benefit is observed
• Educating patients on the importance of adherence and proper use
• Implementing surveillance programs to track resistance patterns

By adopting these practices, clinicians can harness the potential benefits of azithromycin while minimizing the risk of contributing to antimicrobial resistance.

Alternative Macrolides and Non-antibiotic Options

Are there alternative macrolides or non-antibiotic options that could provide similar benefits to azithromycin in chronic respiratory diseases? Exploring these alternatives may help address concerns about antimicrobial resistance:

1. Other macrolides: Erythromycin and clarithromycin have also shown anti-inflammatory properties and may be considered in some cases.
2. Non-antibiotic macrolides: Development of macrolide derivatives that retain anti-inflammatory effects without antimicrobial activity is an area of ongoing research.
3. Novel anti-inflammatory agents: Targeting specific inflammatory pathways involved in chronic cough may provide new treatment options.
4. Combination therapies: Using azithromycin in combination with other treatments may allow for lower doses or shorter durations of therapy.

Further investigation of these alternatives may help expand the therapeutic options for chronic respiratory diseases while preserving the effectiveness of azithromycin and other antibiotics.

Patient Education and Shared Decision-Making

How can healthcare providers effectively communicate the potential benefits and risks of azithromycin treatment to patients with chronic respiratory diseases and cough? Patient education and shared decision-making are crucial components of optimal care.

Key Points for Patient Discussion

When discussing azithromycin as a treatment option, healthcare providers should address the following points:

• The rationale for using an antibiotic for non-infectious purposes
• Expected benefits and timeline for improvement
• Potential side effects and how to manage them
• The importance of completing the prescribed course of treatment
• The risk of antimicrobial resistance and its implications
• Alternative treatment options and their pros and cons

By engaging patients in these discussions, healthcare providers can ensure that treatment decisions align with patient preferences and values while promoting responsible use of azithromycin.

Monitoring and Follow-up

What steps should be taken to monitor patients on azithromycin treatment for chronic respiratory diseases? Regular follow-up is essential to assess treatment efficacy and detect any adverse effects. A monitoring plan may include:

1. Scheduled follow-up appointments to evaluate symptom improvement
2. Use of validated cough assessment tools (e.g., Leicester Cough Questionnaire) to quantify changes
3. Monitoring of lung function and other relevant clinical parameters
4. Regular assessment of potential side effects and drug interactions
5. Periodic review of the need for continued treatment

This proactive approach to monitoring can help optimize treatment outcomes and ensure patient safety.

Economic Considerations in Azithromycin Use for Chronic Respiratory Diseases

What are the economic implications of using azithromycin for chronic respiratory diseases with cough? While not directly addressed in the original text, this is an important consideration for healthcare systems and patients.

Cost-Effectiveness Analysis

Factors to consider in evaluating the cost-effectiveness of azithromycin treatment include:

• Drug acquisition costs compared to alternative treatments
• Potential reduction in healthcare utilization (e.g., emergency department visits, hospitalizations)
• Impact on quality of life and productivity
• Long-term costs associated with managing potential side effects or antimicrobial resistance

Comprehensive economic analyses can help inform policy decisions and guide resource allocation in the management of chronic respiratory diseases.

Access and Affordability

How can equitable access to azithromycin treatment be ensured for patients who may benefit from it? Strategies to address access and affordability issues include:

1. Inclusion in national formularies and insurance coverage
2. Development of generic versions to reduce costs
3. Patient assistance programs for those facing financial barriers
4. Collaboration between healthcare providers, payers, and policymakers to develop sustainable access models

Addressing these economic considerations is crucial for translating the potential benefits of azithromycin into real-world improvements in patient care and outcomes.

Global Perspectives on Azithromycin Use in Respiratory Diseases

How does the approach to azithromycin use in chronic respiratory diseases vary across different countries and healthcare systems? While the original text focuses on Australia and New Zealand, it’s valuable to consider global perspectives.

International Guidelines and Practices

Variations in azithromycin use for chronic respiratory diseases may be influenced by:

• Differences in national treatment guidelines
• Prevalence of specific respiratory conditions in different populations
• Local antimicrobial resistance patterns
• Availability and cost of alternative treatments
• Regulatory approvals and indications

Comparing international approaches can provide insights into best practices and areas for global harmonization in the management of chronic respiratory diseases with cough.

Collaborative Research Initiatives

How can international collaboration enhance our understanding of azithromycin’s role in treating chronic respiratory diseases? Potential areas for global research cooperation include:

1. Multi-center clinical trials to increase sample sizes and generalizability of findings
2. Standardization of outcome measures to facilitate cross-study comparisons
3. Sharing of real-world data on treatment outcomes and safety
4. Joint efforts to develop novel macrolide derivatives or alternative treatments
5. Collaborative approaches to addressing antimicrobial resistance concerns

By fostering international collaboration, the global medical community can accelerate progress in optimizing the use of azithromycin and improving outcomes for patients with chronic respiratory diseases and cough.

The efficacy and safety of azithromycin in chronic respiratory diseases related cough – Zhou

Original Article

Jianmeng Zhou^#, Fang Yi^#, Zhiheng Xu, Lianrong Huang, Ziyu Jiang, Xiaomei Chen, Kefang Lai

State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Contributions: (I) Conception and design: J Zhou, F Yi, X Chen, Z Jiang, K Lai; (II) Administrative support: K Lai; (III) Provision of study materials or patients: Z Xu, L Huang; (IV) Collection and assembly of data: J Zhou, F Yi; (V) Data analysis and interpretation: J Zhou, F Yi, K Lai; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

^#These authors contributed equally to this work.

Correspondence to: Kefang Lai, MD, PhD. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou 510120, China. Email: [email protected].

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Background: Azithromycin is potential for preventing exacerbations in chronic respiratory diseases. However, rare attention was paid to the cough symptom of such airway diseases by azithromycin intervention. We summarized the efficacy and safety of azithromycin in chronic respiratory diseases related cough.

Methods: We searched 4 electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) to identify randomized controlled trials (RCTs) comparing the change of Leicester Cough Questionnaire (LCQ) score, cough visual analogue scale (VAS) and side effects of azithromycin in patients of chronic respiratory diseases with cough.

Results: We identified 5 RCTs (n=879 patients) in pooled analyses. Compared to placebo, azithromycin intervention had no effect in reducing cough [mean difference (MD) 0.73; 95% CI: −0.78 to 2.24; P=0.34] with significant heterogeneity (P=0.03, I²=71%). However, heterogeneity is caused by one study. After removal of this study, azithromycin administration had shown clinically important improvement in LCQ score (MD 1.30; 95% CI: 1.15–1.46; P<0.00001; I²=0%). In addition, no significant difference was detected in adverse events and azithromycin administration probably had less central nervous system side effects for chronic respiratory diseases with cough.

Conclusions: The addition of oral azithromycin may result in significant benefit for chronic respiratory diseases related cough. Azithromycin was safe for those patients with cough.

Keywords: Azithromycin; cough, efficacy; adverse events; systematic review

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Submitted Jan 07, 2020. Accepted for publication May 27, 2020.

doi: 10.21037/apm-20-119

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Introduction

Cough is one of the most common respiratory symptom, which affects 8–10% of the adult population, leading to seek medical care in western countries as well as in China (1-3). Chronic respiratory diseases causing cough include asthma, eosinophilic bronchitis, postnasal drip syndrome or rhinosinusitis, chronic obstructive pulmonary disease (COPD), bronchiectasis, etc. (1,4,5). The management of these patients should be aimed at pathogeny cure. Several treatments for chronic respiratory diseases with cough have been identified over the past decades, including inhaled corticosteroids (ICS), neuromodulatory therapies, non-pharmacologic therapies and other therapies (6-8).

Generally, ICS, β2 adrenergic receptor agonist and muscarinic receptor antagonist have been proposed to be the basic treatments for chronic respiratory diseases, including asthma and COPD (9,10). After inhalers, advanced therapies are also available, including phosphodiesterase inhibitors, leukotriene receptor antagonist, N-acetylcysteine, even immunotherapy (monoclonal antibodies) (9,10). However, their treatment response often limited in case of refractory cough (8,11,12). Therefore, better approaches to chronic respiratory diseases with cough are needed.

Besides antibacterial effects, azithromycin, as a kind of macrolide antibiotics, has been reported to have anti-inflammatory and immunomodulatory effects in chronic airway inflammatory diseases, including bronchiectasis, COPD, asthma (13-16). A recently meta-analysis assessed the efficacy and safety of long-term add-on treatment of azithromycin in asthma (17). They mainly focused on the therapeutic effect of azithromycin in lung function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)], symptom control, quality of life [Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ)] and airway inflammation (16,17). However, rare attention was paid to the cough symptom of such airway diseases, which had greater impact on quality of life for some patients than other symptoms (18,19). Therefore, we did a systematic review aiming to provide a summary of the efficacy and safety of azithromycin in patients of chronic respiratory diseases with cough. We present the following article in accordance with the PRISMA reporting checklist (available at http://dx.doi.org/10.21037/apm-20-119).

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Methods

Inclusion and exclusion criteria

We included prospective randomized controlled trials (RCTs) involving patients of chronic respiratory diseases with cough. Azithromycin should be administrated as compared with placebo or in combination with other treatments as compared with other treatments alone. We limited publications to the English language. We excluded crossover trials, abstract publications, before-after studies, conference presentations, editorials and case reports. No statement on medical ethics is required for the systematic review and meta-analysis.

Search strategy

To increase the sensitivity of the search strategy, we combined the terms “azithromycin” with “cough” as key words or Medical Subject Headings (MeSH) terms. Four databases, including PubMed, EMBASE, Cochrane, and Web of Science, were searched from electronic databases inception to October, 1st, 2019. We systematically screened abstracts and full text articles for studies that met our eligibility criteria. The process was performed by two researchers (J Zhou and F Yi) independently.

Outcome assessment

The primary outcome of this review was the improvement of cough, assessed by Leicester Cough Questionnaire (LCQ), the Cough Quality-of-Life Questionnaire (CQLQ) and the cough visual analogue scale (VAS). The secondary outcome was the incidence of adverse effects by azithromycin for the treatment of cough.

Data abstraction

Two investigators (J Zhou and F Yi) reviewed and abstracted data from each retrieved article and supplement independently. Discrepancies were resolved by discussion and consensus.

Quality assessment

The quality of all included trials was reviewing by the details in their method sections and their supplemental materials. The trial quality was appraised by using the Cochrane collaboration tool for assessing risk of bias (RoB) (20), including assessment of random sequence generation, allocation concealment, blinding (of interventions, outcome measurement or assessment), selective reporting bias and incomplete outcome data. For each criterion, we appraised the RoB to be either of low, high, or unclear risk. Two researchers (J Zhou and F Yi) assessed the trial quality independently and disagreements were resolved by discussion.

Assessment of heterogeneity

We used the I² statistic to evaluate the heterogeneity on pooled data. If an I² value was greater than 50%, then a substantial heterogeneity was indicated (20). Fixed-effects model was used to pool data when heterogeneity was insignificant. When significant heterogeneity was found, then the random effects models would be used to pool data.

Statistical analysis

The changes in LCQ score and adverse events rates were analysed in this meta-analysis. Continuous data and categorical data were pooled by using the mean difference (MD) and risk ratio (RR), with the 95% confidence intervals (CIs). The comparison of the outcome between the azithromycin and placebo was conducted with Review Manager (RevMan) Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014), and two-sided P values less than 0.05 were considered to be statistically significant.

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Results

Characteristics of included trials

We identified 302 potentially eligible studies. After exclusion of duplicate and irrelevant articles, 16 studies were retrieved to be reviewed in greater detail. Of these, we excluded 11 studies that did not meet our eligibility criteria and thus included 5 trials in our review (Figure 1). All of the included studies were designed as randomised, double-blind, placebo-controlled clinical trials. Of the 5 RCTs, two studies were conducted in patients with asthma (15,21), one study was conducted in patients with COPD (22). Hodgson et al. conducted a study in patients with bronchial hyperresponsiveness (23). Saiman et al. conducted a study in patients with cystic fibrosis uninfected with Pseudomonas aeruginosa (24). The characteristics of the studies are shown in Table 1.

Figure 1 Search strategy of meta-analysis on selecting patients for inclusion.

Table 1 Characteristics and designs of the included studies
Full table

RoB of included studies

All included trials were reported to be low risk of performance bias and four studies were assessed to be at low RoB with respect to selection bias except for one study for which selection bias was deemed unclear (21). Two trials assessed to be at low RoB with regard to completeness of outcomes data, selective outcomes reporting, and other potential sources of bias (15,24). But the other three trials were considered to be at unclear risk with respect to the above bias (21-23) (Figure 2).

Figure 2 Risk of bias for each study. Green represents low risk of bias, yellow represents unclear risk of bias.

Azithromycin in cough

Cough can be assessed by many ways and the LCQ has been well validated with internal consistency, repeatability and responsiveness (25,26). However, only three of the included trials have reported the change of LCQ (21-23). Compared to placebo, azithromycin intervention had no effect in reducing cough (n=198, MD 0.73; 95% CI: −0.78 to 2.24; P=0.34; I²=71%). Further analysis showed that the trial from Cameron et al. (21) was main source of heterogeneity. When excluding the above trial, the left two trials (22,23) had shown clinically important improvement in LCQ score by azithromycin administration (n=121, MD 1.30; 95% CI: 1.15–1.46; P<0.00001; I²=0%) (Figure 3).

Figure 3 Azithromycin in chronic respiratory diseases with cough. Green represents low risk of bias, yellow represents unclear risk of bias. A: Random sequence generation; B: allocation concealment; C: blinding of participants and personnel; D: blinding of outcome assessment; E: incomplete outcome data; F: selective reporting; G: other bias.

There other two studies did not assessed cough by LCQ. The study from Saiman et al. showed that azithromycin intervention significantly reduced the frequency of cough (−23% treatment difference; 95% CI: −33 to −11; P<0.001) and productive cough (−11% treatment difference; 95% CI: −19 to −3; P=0.01) than those in placebo group (24). Another study from Gibson et al. measured cough by using cough VAS. They found that there was a significant reduction in cough and sputum production VAS in patients using azithromycin (15). No included study measured cough by using CQLQ.

Adverse events

There were four trials report the adverse events during azithromycin intervention (15,22-24). A pooled analysis applied in a random effect model revealed that there was no significant difference in upper respiratory (n=808, RR 1.11; 95% CI: 0.68–1.79; P=0.68), gastrointestinal (n=808, RR 0.95; 95% CI: 0.26–3.50; P=0.94) and other adverse events (n=808, RR 0.91; 95% CI: 0.49–1.70; P=0.77) between the two groups. However, pooled data showed that azithromycin intervention had less central nervous system than the placebo in a fixed effect model (heterogeneity I²=7%, P=0.03) (Figure 4).

Figure 4 Side effects of azithromycin. Green represents low risk of bias, yellow represents unclear risk of bias. A: Random sequence generation; B: allocation concealment; C: blinding of participants and personnel; D: blinding of outcome assessment; E: incomplete outcome data; F: selective reporting; G: other bias.

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Our systematic review pooled the data of 879 patients of chronic respiratory diseases with cough from five randomised, placebo controlled clinical trials to evaluate the efficacy of azithromycin on cough. It showed that the addition of oral azithromycin to standard care for the associated respiratory diseases resulted in no statistically significant benefit for reducing cough in three eligible trials but with significant heterogeneity. After excluding the substantial heterogeneity trial, we found that addition of oral azithromycin could improve LCQ score and cough VAS score, reduce the incidence of cough. In addition, the treatment was well-tolerated. No significant side effect of azithromycin treatment was found. And pooled data showed that azithromycin intervention had less central nervous system than the placebo.

Azithromycin, a macrolide antibiotic with a broader microbial spectrum and fewer side effects was recommended in many indications. However, azithromycin was reported to play an important role in anti-inflammatory and immunomodulatory activities independent of their antimicrobial activity in chronic respiratory diseases, including bronchiectasis, COPD, asthma etc. (13-15). More importantly, azithromycin was demonstrated to prevent exacerbations in chronic respiratory diseases (27). A significant decrease in the exacerbation rate of cystic fibrosis patients with chronic Pseudomonas infection was reported after using azithromycin (28,29). Maintenance treatment with azithromycin significantly decreased the frequency of exacerbations and improved quality of life of COPD patients (14,30). Azithromycin also succeeded in reducing the exacerbation rate of persistent uncontrolled asthma (15). Azithromycin was considered to be the holy grail to prevent exacerbations in chronic respiratory diseases (27).

Cough, as one of the most common symptoms in chronic respiratory diseases, was usual to be overlooked. Cough could be difficult to treat and contributed to poor quality of life, with a significant impact on physical, psychological, and social activities (19,23). Based on a clinical founding of a dramatic improvement in patients with chronic respiratory diseases treated with azithromycin, we mainly focused on the efficacy and safety of azithromycin in symptoms of cough. Therefore, we conducted a systematic review of the literatures and the pooled data had shown that azithromycin had no statistically significant benefit for reducing cough but with significant heterogeneity. The trial from Cameron et al. (21) might be the main source of heterogeneity. There were unclear risks of selection bias (including assessment of random sequence generation, allocation concealment), selective reporting bias and attrition bias due to lack of such information in the manuscript. However, the other two trials (22,23) had shown low risk of selection bias, performance bias and detection bias. And the pooled data of the two trials showed a clinically important improvement in LCQ score by azithromycin administration. Similarly, another two eligible trials with low risks of bias also showed that azithromycin intervention significant reduced both the incidence of cough (24) and the cough VAS score (15). Therefore, additional azithromycin administration maybe benefits for patients of chronic respiratory diseases with cough in a well-designed and high-quality trial.

Eosinophilic inflammation is an important cause of cough symptom (31,32). The possible mechanism of azithromycin in relieving cough may be an anti-inflammatory effect both systemically and locally within the airway. Azithromycin has complex immunomodulatory effects on eosinophilic airway inflammation and inhibition of cytokine production (33,34). Moreover, azithromycin could suppress CD4⁺ T-cell activation by direct modulation of mTOR activity, which inhibited eosinophil differentiation and allergic inflammation (35,36). Therefore, additional azithromycin administration maybe benefits for patients of chronic respiratory diseases with cough.

For the safety analysis, we classified nasal congestion, pharyngolaryngeal pain, rhinorrhea, common cold, cough into upper respiratory side effects. Vomiting, upper abdominal pain, nausea, diarrhea, ulcus ventriculi, abnormal liver function tests were classified into gastrointestinal side effects. Pyrexia, fatigue, vertigo, tinnitus, hearing loss headache were classified into central nervous system side effects. Other adverse events included rash, allergy, oral thrush, QTc prolongation, back pain, rib pain, myocardial infarction, supraventricular tachycardia, heart failure, hyperhidrosis, malaise etc. We found that there was no significant difference in upper respiratory, gastrointestinal and other adverse events of azithromycin treatment in patients of chronic respiratory diseases with cough. Moreover, azithromycin intervention had less central nervous system than the placebo. Therefore, additional azithromycin administration may be safety for patients of chronic respiratory diseases with cough.

There were several limitations in this meta-analysis. Firstly, the eligible trial was limited and the sample size was relatively small, the conclusion of our analysis might be carefully made before transferring to a large cough population. Secondly, potential publication bias may not be ignored and we failed to identify potential unpublished negative studies that may alter the outcome. In addition, the heterogeneity derived from the design of an RCT, causes of cough, baseline treatment, the dosage and period of azithromycin treatment among studies, which might contribute to the inconsistency. Finally, for the safety analysis, side effects were classified into certain scale such as upper respiratory and gastrointestinal adverse events rather than one side effect by one comparison, which may cover certain significant side effects.

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Conclusions

Our systematic review and meta-analysis found that the addition of oral azithromycin to standard care for the associated respiratory diseases resulted in statistically significant benefit for patients with cough. Azithromycin administration was safety and probably showed less central nervous system side effects for patients with cough. However, more RCTs with large sample size should be conducted to establish the precise role of azithromycin in the chronic respiratory diseases related cough treatment.

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Acknowledgments

Funding: None.

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Footnote

Reporting Checklist: The authors have completed the PRISMA reporting Checklist. Available at http://dx.doi.org/10.21037/apm-20-119

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/apm-20-119). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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24. Saiman L, Anstead M, Mayer-Hamblett N, et al. Effect of azithromycin on pulmonary function in patients with cystic fibrosis uninfected with Pseudomonas aeruginosa: a randomized controlled trial. JAMA 2010;303:1707-15. [Crossref] [PubMed]
25. Birring SS, Spinou A. How best to measure cough clinically. Curr Opin Pharmacol 2015;22:37-40. [Crossref] [PubMed]
26. Birring SS, Prudon B, Carr AJ, et al. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax 2003;58:339-43. [Crossref] [PubMed]
27. Welte T. Azithromycin: The Holy Grail to Prevent Exacerbations in Chronic Respiratory Disease? Am J Respir Crit Care Med 2019;200:269-70. [Crossref] [PubMed]
28. Saiman L, Marshall BC, Mayer-Hamblett N, et al. Azithromycin in patients with cystic fibrosis chronically infected with Pseudomonas aeruginosa: a randomized controlled trial. JAMA 2003;290:1749-56. [Crossref] [PubMed]
29. Mayer-Hamblett N, Retsch-Bogart G, Kloster M, et al. Azithromycin for Early Pseudomonas Infection in Cystic Fibrosis. The OPTIMIZE Randomized Trial. Am J Respir Crit Care Med 2018;198:1177-87. [Crossref] [PubMed]
30. Uzun S, Djamin RS, Kluytmans JA, et al. Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2014;2:361-8. [Crossref] [PubMed]
31. Brightling CE. Eosinophils, bronchitis and asthma: pathogenesis of cough and airflow obstruction. Pulm Pharmacol Ther 2011;24:324-7. [Crossref] [PubMed]
32. Lai K, Chen R, Peng W, et al. Non-asthmatic eosinophilic bronchitis and its relationship with asthma. Pulm Pharmacol Ther 2017;47:66-71. [Crossref] [PubMed]
33. Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ, et al. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther 2014;143:225-45. [Crossref] [PubMed]
34. Hiles SA, McDonald VM, Guilhermino M, et al. Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis. Eur Respir J 2019;54:1901381. [Crossref] [PubMed]
35. Ratzinger F, Haslacher H, Poeppl W, et al. Azithromycin suppresses CD4(+) T-cell activation by direct modulation of mTOR activity. Sci Rep 2014;4:7438. [Crossref] [PubMed]
36. Hua W, Liu H, Xia LX, et al. Rapamycin inhibition of eosinophil differentiation attenuates allergic airway inflammation in mice. Respirology 2015;20:1055-65. [Crossref] [PubMed]

Cite this article as: Zhou J, Yi F, Xu Z, Huang L, Jiang Z, Chen X, Lai K. The efficacy and safety of azithromycin in chronic respiratory diseases related cough. Ann Palliat Med 2020;9(4):1488-1496. doi: 10.21037/apm-20-119

Azithromycin For Cough – 223 Questions Answered

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Azithromycin For Cough

Asked for male, 49 years

I’m a 49 year old male, I have had a reoccurring pain on the right side of my abdomen, just below the ribcage, the pain is severely worse when I cough, burp, sneeze or breath in too much, I cannot sleep on my left or right side or my back, I have no prior history of any other medical ailments, i’m not on any medication, the only thing I take is a headache tablet when the need arises, I used a course of azithromycin 500 mg the first 2 times and it seemed to help my situation.

What could possibly be causing my distress?

Dr. Anmol Godara

96% (418 ratings)

MBBS Bachelor of Medicine and Bachelor of Surgery

General Physician, Hisar

Could be muscular pain, liver and gallbladder problem or pleuritis also.
Best choice would be cbc, lft and usg abdomen.
Taking too antibiotics may cause problem of their own. Do contact me for further diagnosis and treatment if you feel necessary.

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Asked for male, 3 years old from Kharagpur

What is the dose of azithromycin of children aged 3 years, weight 18 kg, symptoms is fever, nasal block, and cough.

Dr. Subhash Divekar

92% (3191 ratings)

Certificate in Basic Course on Diabetes Management

General Physician, Pune

Usual dosage of azithromycin is 10 mg/kg body weight once a day fro 3-5 days. Since this is an antibiotic and for a 3 years old child you are advised to consult a physician or child specialist and under his/her supervision.

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Asked for Male, 25 years old from Ahmedabad

I have cough n cold from yesterday. And a little bit of headache and body pain. And throat mai which which. Can I take azithromycin 250 mg for that?

Dr. G.R. Agrawal

96% (37997 ratings)

DHMS (Hons.)

Homeopathy Doctor, Patna

Hi, lybrate user,
•It indicates exposure to cold ,experiencing cough cold, bodyache and headache .
•I being a homoeo consultant can suggest you some recourse in homoeopathy, please.
•Tk, lukewarm water to hydrate your body.
Inhale steam, twice.
•Tk, homoeopathic medicine, underlying :
@ Arsenic album 30ch -5 drops, once morning.
@ Eupetorium perf 30ch -5 drops, thrice.
•Avoid , junk food, alcohol and nicotine.
Tk, care.

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Asked for male, 19 years old from Kolkata

I am an 18 year old male, I had cough, cold 10 days ago and I took azithromycin, then 4 days ago I got loose motion also, at first I thought it will go on its own, but it didn’t stop, so yesterday I took o2, now my symptoms are vomiting, severe headache and fever has not stopped, we have dengue patients in kit ,so I am suspecting whether I have dengue, please help.

Dr. Subodh Bhalke

90% (2465 ratings)

M.D. (Alt. Med.), BHMS, PGDPC

Homeopathy Doctor, Nashik

Do not worry ,do cbc test & start
homeopathic medicine
1. eupatorium 30 .4 drops at morning
2.eucalyptus 30.4 drops afternoon
3.nux vomica 30.4 drops night
(for 7 days)

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Asked for male, 17 years old from Cuttack

I am 17 years old boy and now I am suffering from severe cough and blocked runny nose. My problem is when I cough in the morning before 9 am some blood is coming out and there are no signs of blood in cough for the rest of the day. Dry cough and difficult in breathing are other problems of mine. I am taking azithromycin, pantoprazole and montefex as advised by a general physician. I think it may be acute bronchitis or something but I am afraid of the blood in the morning cough. Is it due to pressure on my throat or something else please advise me. I have done x-ray and doctor said that there is cough in my chest and wbc is of 12.96 and gram +ve cocci in my cough. please help me.

Dr. Amit Kumar Poddar

92% (928 ratings)

MBBS, MD Tuberculosis And Chest Diseases, Diploma in Tuberculosis & Chest Diseases, Diploma in Tropical Medicine and Hygiene

Pulmonologist, Kolkata

you need budamate 200 MCG. mdi
1puff twice daily to continue.
rinse your mouth with drinking
water 5 minutes after inhalation

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Asked for male, 20 years old from Jaipur

Fever with cold and mild cough last 2 days se ho rha azithromycin strt krr di but isse loose motion lgg rhe.

Dr. G.R. Agrawal

96% (37997 ratings)

DHMS (Hons. )

Homeopathy Doctor, Patna

Hi, lybrate user,
It indicates onset of viral infection.
Drink,lukewarm water .
Inhale, steam, once.
Tk, homoeopathic medicine, underlying :
@ Arsenic album 30ch-5 drops, once, daily .
@ Bryonia album 30ch -5.droos x 3, daily.
Avoid , junk food, alcohol, cold intake and nicotine.
Tk care.

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Health Query

Hi, my daughter is 5 years old, she has been suffering from dry cough for the past three months (1 month in chennai and past two months in bangalore). Initially had only during night, but past 2 weeks she has at day time as well and some time cough continuously for 1 to 2 minute. We tried all the below medications with no response. Allegra, ascoril, alex -junior montclair with levocetirizine, azithromycin and even budecort nebulizer.

No response at all. We consulted three different pediatrician they say lungs are clear and no abnormality in chest. All say this might be viral flu and dry cough is defense mechanism. But she is suffering for 3 months. Please if any one can help suggest?

Dr. Amit Kumar Poddar

92% (928 ratings)

MBBS, MD TUBERCULOSIS AND CHEST DISEASES, Diploma in Tuberculosis & Chest Diseases, Diploma in Tropical Medicine and Hygiene

Pulmonologist, Kolkata

She should take seroflo 50 mdi
1puff twice daily; x90 days.
Mouth should. Be rinsed with water
after 5 minutes.

1
person found this helpful

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Asked for male, 63 years old from Mumbai

Right side nose stuffy.

Excessive gas formation, belching etc. Recently, fever and cough was there. Crocin and azithromycin taken. Fever went. Now cough is more deep and feels as if dry cough is there but nothing or very little sputum comes out.

Dr. Amit Kumar Poddar

92% (928 ratings)

MBBS, MD TUBERCULOSIS AND CHEST DISEASES, Diploma in Tuberculosis & Chest Diseases, Diploma in Tropical Medicine and Hygiene

Pulmonologist, Kolkata

to drink plenty of fluid
warm saline gargle twice daily x 7days
steam inhalation twice daily x 7 days

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what can and should be taken

Contents

• 1 Which antibiotics are effective in treating dry cough in adults?
  • 1.1 Antibiotics for dry cough in adults: what can and should be taken
    • 1.1.1 Brief introduction
  • 1.2 When to take antibiotics for dry cough
  • cough in adults
  • 1. 4 How taking antibiotics correctly for dry cough
  • 1.5 Main side effects of antibiotics
  • 1.6 Misconceptions about treating dry cough with antibiotics
    • 1.6.1 Misconception 1: Antibiotics help with dry cough
    • need to take antibiotics
    • 1.6.3 Misconception 3: Antibiotics can be used to prevent dry cough
  • 1.7 Antibiotics for dry cough: what to avoid
  • 1.8 Antibiotics for dry cough in adults: which to use and when to use
  • 1.9 Comprehensive treatment of dry cough in adults
    • 1.9.1 Medicines
    • 1.9.2 Folk remedies
  • 1.10 Consultation with a doctor before taking antibiotics for dry cough

  900 05 1.11 Related video:

  • 1.12 Q&A:
    • • 1.12.0.1 Can antibiotics help with a cough caused by an allergy?

Find out which antibiotics adults can take for dry cough based on risks and side effects. Get helpful tips and advice from qualified doctors and get rid of unpleasant cough symptoms quickly and safely.

A dry cough is not usually a major health hazard, but it can be long lasting and uncomfortable. This is a common occurrence, mostly caused by the flu or a cold, but can be a sign of more serious illnesses such as asthma or pneumonia.

The answer to the question of whether to take antibiotics for dry cough in adults is not so simple. In most cases, dry cough is caused by a viral infection and cannot be treated with antibiotics. However, if the cough is caused by a bacterial infection, antibiotics may be effective.

If you have a dry cough and think you need antibiotics, you should see your doctor. Only a professional can assess your condition and prescribe the necessary course of treatment. Remember that the misuse of antibiotics can lead to serious consequences.

Antibiotics for dry cough in adults: what can and should be taken

Brief background information

Dry cough can occur as a result of SARS, bronchitis and other diseases. If the temperature does not rise with a dry cough in an adult and there are no other symptoms that indicate a disease caused by bacteria, antibiotics are not needed. A dry cough usually goes away on its own within 1-3 weeks.

However, not all antibiotics are suitable for treating coughs. They differ in mechanism of action and scope of action. Some antibiotics are only effective against certain bacteria, others can be used on a wide variety of bacteria. Therefore, the correct choice of antibiotic depends on the type of bacteria causing the infection.

When to take antibiotics for dry cough

Dry cough is a symptom of many diseases, including acute bronchitis, pneumonia and other infectious diseases. Often a dry cough is caused by a viral infection, in which case antibiotics are not required.

However, if dry cough symptoms worsen, body temperature rises, breathing becomes fast and the throat becomes red, this may indicate a bacterial infection that requires antibiotic treatment.

It is important to consider that bacterial resistance may develop if antibiotics are used incorrectly. Therefore, it is recommended to consult a doctor and undergo all the necessary examinations for an accurate diagnosis. Only after that, the doctor can prescribe an antibiotic, taking into account the characteristics of the disease and the patient’s state of health.

Symptoms Probable cause Need for antibiotics

90 089 Dry cough, body temperature above 37.5°C, rapid breathing, redness of the throat

Dry cough, body temperature up to 37.5°C	Viral infection	Not required
Bacterial infection	You can prescribe antibiotics after consulting a doctor and passing all the necessary examinations

Do not forget that taking antibiotics is a serious medical prescription that should only be carried out under the supervision of a doctor.

Types of antibiotics for dry cough in adults

Antibiotics are a class of medicines that are used to treat bacterial infections. Dry cough can be caused by both bacterial and viral infections. If the cause is a bacterial infection, antibiotics may help relieve cough symptoms.

There are several types of antibiotics that are effective for dry cough. These include:

• Amoxicillin . This antibiotic belongs to the penicillin class and is used primarily to treat respiratory tract infections such as bronchitis and pneumonia.
• Clarithromycin . This antibiotic belongs to the macrolide class and is commonly used to treat infections caused by the bacterium Haemophilus influenzae. Clarithromycin may be called if amoxicillin does not work.
• Doxycycline . This antibiotic belongs to the tetracycline class. It is often used to treat chronic bronchitis as well as other respiratory tract infections.

The need for antibiotics for dry cough should be determined only by a doctor after diagnosis and determination of the cause of the disease. Misuse of antibiotics can lead to the development of antibiotic resistance and complications in the future.

How to take antibiotics for dry cough

Check the diagnosis first. Before taking any medication, you need to make sure that your dry cough is caused by a bacterial infection. The doctor will diagnose and make the correct diagnosis.

Choose antibiotics according to the diagnosis. Each type of bacteria is sensitive to certain groups of antibiotics. Therefore, if the type of bacteria that caused the cough is determined, the choice of a specific drug will be justified.

Follow the recommended dosage. Do not forget that the dosage of antibiotics depends on your ailment and weight, age and other individual characteristics. Do not exceed dosage without consulting your doctor.

Finish your course of antibiotics. Taking antibiotics may take 5 to 10 days. It is important to finish the course, even if a few days before the end of the cough symptoms disappear, in order to avoid the risk of re-infection and the development of bacterial resistance.

Keep a proper daily routine. During treatment with antibiotics, the correct daily routine should be observed, the diet should be reviewed and the intake of other drugs should be monitored. Avoid alcohol, dairy products, coffee, and other substances that may reduce the effectiveness of antibiotics.

Common side effects of antibiotics

Antibiotics are medicines used to fight bacterial infections. However, taking antibiotics can cause a number of side effects, the most common of which are:

Allergic reactions: in rare cases, antibiotics can cause an allergic reaction, manifested by hives, itching, swelling of the larynx.

Toxicity: Some antibiotics can be toxic to the kidneys and liver and should be taken under medical supervision.

Weakening of the immune system: prolonged use of antibiotics can lead to a decrease in immunity and a deterioration in the general condition of the body.

Before starting antibiotics, always consult your doctor and strictly follow the instructions for use. Incorrect use of antibiotics can not only not lead to the desired effect, but also cause significant harm to health.

Misconceptions about treating dry coughs with antibiotics

Misconception 1: Antibiotics help with dry coughs

Many people believe that antibiotics are a universal remedy for any cough, including dry coughs. However, you should not take these drugs on your own, without the advice of a doctor. Antibiotics do not help with a dry cough if it is caused by a virus. These medicines are only effective against bacteria, and viruses tend to be the most common cause of colds.

Misconception 2: The worse the cough, the more antibiotics you need to take

Most people think that if you have a bad cough, you need to increase the dosage of antibiotics for a faster recovery. This is not true. This approach to treatment increases the likelihood of developing side effects and diseases caused by resistant bacteria. Antibiotics should be taken only as prescribed by a doctor who will select the optimal regimen and dosage.

Misconception 3: Antibiotics can be used to prevent dry cough

Many people use antibiotics not only for medical purposes, but also to prevent various diseases, including dry cough. However, this is not only useless, but also dangerous. Incorrect use of antibiotics can lead to the development of bacterial resistance, making it harder to treat infections later.

Adults need to understand that a dry cough is not always a symptom of an illness that needs to be treated with antibiotics. In most cases, a dry cough is a temporary disorder of the body and can be treated with safer methods such as taking expectorants and drinking plenty of water. In case of severe cough and fever, you should consult your doctor to prescribe adequate therapy.

Antibiotics for dry cough: what to avoid

Dry cough can be caused by a wide range of conditions, but not all require antibiotic treatment. If the cause of the cough is a viral infection, antibiotics may be pointless. What’s more, some antibiotics can be harmful to your health, especially when treating a dry cough.

Amoxicillin. This drug is in the penicillin class and may not be strong enough to treat a dry cough. Moreover, it can provoke allergic reactions, so you should avoid using it if you have some allergies.

Azithromycin. Although this macrolide antibiotic may help with more serious infections, it cannot be recommended for the treatment of dry cough. It can have many side effects and cause diarrhea, nausea, and vomiting.

Doxycycline. This drug may be used to treat bacterial infections but is not recommended for dry cough. It can also have unwanted side effects such as esophageal irritation and digestive problems.

The information provided here is not medical advice. If you suffer from dry cough, see your doctor for treatment advice.

Antibiotics for dry cough in adults: what to use and when to use it

Dry cough is a fairly common problem that can occur in adults due to various reasons. However, in most cases it goes away on its own without the need for medication. However, if the cough lasts for more than a week, it may signal a more serious problem and a doctor may recommend antibiotics.

Some of the antibiotics that are often prescribed to treat dry cough in adults include:

• Azithromycin: This antibiotic is often used to treat respiratory tract infections, including bronchitis and pneumonia.
• Amoxicillin: is one of the most commonly recommended antibiotics for respiratory infections. It may also be used to treat other bacterial infections.
• Doxycycline: is an antibiotic often used to treat respiratory tract infections such as bronchitis and pneumonia. It can also be used in the treatment of other diseases caused by bacteria.

It is important to understand that antibiotics only work on bacterial infections and will not help with viral illnesses such as colds or flu. Therefore, before taking antibiotics, it is necessary to diagnose and find out the cause of the cough.

Also keep in mind that antibiotics have side effects, so they should only be taken as prescribed by a doctor and in accordance with his instructions. Using antibiotics without a real need can lead to a number of serious problems, including antibiotic resistance and problems with the digestive system.

Complex treatment of dry cough in adults

Medications

One of the main means in the treatment of dry cough in adults are antibiotics that can destroy a bacterial infection. However, if the cause of the cough is not a bacterial infection, but an allergy or a virus, antibiotics will not be effective. In such cases, to reduce dryness and reduce the frequency of coughing, you can take antitussives, as well as drugs that moisturize and soften the throat.

It must be remembered that when taking antibiotics, it is necessary to monitor the condition of the stomach and intestines, as they can cause dysbacteriosis and indigestion. To prevent such conditions, it is recommended to take drugs that restore the microflora of the gastrointestinal tract.

Folk remedies

In addition to drugs, dry cough can also be treated with folk remedies. For example, warming infusions based on medicinal herbs such as thyme, plantain and thyme. You can also use honey, lemon, ginger and other products that help relieve inflammation and reduce coughing.

It is important to understand that when choosing folk remedies, it is necessary to take into account individual sensitivity to certain components. It is also worth remembering that folk remedies cannot replace full-fledged treatment and consultation with a specialist.

Doctor’s advice before taking antibiotics for dry cough

Adults should always consult a doctor before taking antibiotics for dry cough. There are many factors that can influence the choice of antibiotic, such as age, comorbidities, allergic reactions, etc.

In addition, the doctor will also tell you to follow the correct dosage of the drug and the duration of the course of treatment. Violation of this recommendation may lead to insufficient effectiveness of treatment or deterioration in general health.

Do not forget that self-medication can be hazardous to health, so do not take antibiotics without first consulting a doctor. Health is the most important aspect of life, therefore it is necessary to treat it with due responsibility and care.

Related videos:

Q&A:

Can antibiotics help with a cough caused by an allergy?

No, antibiotics will not help with a cough caused by an allergy, as an allergic cough is associated with an increased sensitivity of the immune system to certain substances, and is not associated with a bacterial infection. For the treatment of allergic cough, antihistamines and other specialized drugs should be taken.

Azithromycin – new horizons of the well-known. Short course of therapy

One of the frequent complications of acute respiratory viral infection (ARVI) is bacterial superinfection. They usually develop on the 5th-7th day and may be manifested by worsening and / or a change in the symptoms that are usually noted with ARVI. Complications of SARS can be both infections of the upper (sinusitis, tonsillopharyngitis) and lower respiratory tract (bronchitis, pneumonia).

Pneumonia is often caused by microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus , atypical flora (the role of the latter at the present stage has increased to approximately 25%, and in some countries – up to 50%). The spectrum of causative agents of acute bacterial bronchitis echoes that of pneumonia (in 45%, typical pathogens are isolated, and in 25% of cases, atypical pathogens). It should be remembered that much more often the cause of acute bronchitis is a viral infection (70-90%) than a bacterial one. Thus, the basis of the treatment of pneumonia is antibiotic therapy. Adequately and timely antibiotic therapy is a necessary condition for effective treatment and, consequently, a favorable outcome of pneumonia. A clear understanding of which microorganism caused the disease helps the doctor more accurately prescribe antibiotic therapy. Equally important is the duration of the antibacterial course in the treatment of pneumonia.

What antibiotics do doctors prescribe?

Antibacterial therapy is prescribed empirically, without waiting for the result of a microbiological study. Therefore, in this case, it is necessary to use drugs with high activity against the most likely pathogens of pneumonia, an optimal safety profile, the ability to create high concentrations in lung tissues, biological fluids, an advantageous cost / effectiveness ratio, a convenient dosing regimen (ideally – 1 time per day), allowing patients to maintain high adherence to the chosen method of therapy, which is especially important in outpatient treatment of socially active population groups.

The drug of choice in the treatment of pneumonia is amoxicillin tablets or macrolide (the latter is preferred if atypical flora is suspected). It is desirable to prescribe an antibacterial drug with improved pharmacokinetic properties and a favorable safety profile (for example, azithromycin). The spectrum of activity of macrolides, which include azithromycin, is quite wide: gram-positive microorganisms ( S. pneumoniae, S. aureus , group A β-hemolytic streptococcus), atypical flora, M. catarrhalis and H. influenzae . The arsenal of agents that combine the ability to influence S. pneumoniae and atypical flora and can be used as an alternative to macrolides is limited.

In case of suspicion of an atypical nature of pneumonia, macrolides also play the role of the first violin. In school-age children, M. pneumoniae is recognized as the dominant pathogen, , therefore, it is believed that macrolides have virtually no competitors in pediatric practice.

Important! Duration of antibiotic therapy

In the treatment of acute bronchitis of a bacterial nature and pneumonia, the correct choice of antibiotic and the adequate duration of its administration are equally important. The question of the duration of antibiotic therapy for pneumonia is often the subject of discussion. There are often conflicting opinions, sometimes completely wrong. For example, some representatives of the “old guard” of doctors still insist on a “battle to the bitter end”, that is, on antibiotic therapy until the complete disappearance of clinical and radiological symptoms, and the normalization of the blood picture. Meanwhile, the mission of an antibacterial drug is only to play the role of a killer in relation to pathogens; therefore, long-term use of these funds is not advisable. It is not required to carry out treatment until the radiological resolution of pneumonia. It is believed that the radiographic picture returns to normal after 1–3 months on average. In acute bacterial bronchitis, as a rule, a 3- (if we are talking about azithromycin) or 5-day course of antibiotics is prescribed, in case of pneumonia ≥5 days. A short course of antibiotics is justified in patients with a mild course of the disease, while in elderly patients with comorbid pathology or in the case of a slow clinical response, this strategy does not always provide a positive result. In patients with mild pneumonia, antibiotic therapy can be completed within 3–5 days after normalization of body temperature (the total duration of treatment is 7–10 days). If clinical or epidemiological data are obtained in favor of mycoplasma or chlamydial infection, it is recommended to increase the course to 10-14 days.

The recommendations of authoritative organizations – the American Thoracic Society (2001), the British Thoracic Society (2001) – also focus on longer treatment of community-acquired pneumonia caused by atypical flora: 10–14 and 14 days, respectively. According to some statistics (data from MDM, 2015), about 40% of doctors recommend azithromycin treatment for more than 3 days to their patients, and this is no coincidence. There are a number of respiratory tract infections that are caused by intracellular pathogens, and such cases require longer treatment.

Role of the pharmacist

If a patient is scheduled to take antibiotics for more than 3 days, the pharmacist should be offered a package of the drug that is guaranteed to provide him with this course of therapy. After all, premature termination of treatment threatens with the development of complications, chronicity of the process, and an increase in antibiotic resistance. It is important to remember that the antibacterial drug is selected by the doctor individually, depending on the comorbidity, the presence of microbial flora, the tolerance of the drug, etc. At the same time, azithromycin has important pharmacokinetic properties for the treatment of pneumonia, such as a long half-life, the presence of an anti-inflammatory effect, the ability to accumulate inside cells and in the focus of inflammation. It creates intracellular concentrations that exceed the minimum inhibitory concentrations for major pathogens. After stopping the drug, the therapeutic level in the blood remains for a long period (5-7 days). Considering the high activity of azithromycin against key pathogens of pneumonia and the increasing role of atypical flora in the etiology of upper respiratory tract infections, the drug can be considered as the therapy of choice in patients with acute bacterial bronchitis and mild pneumonia. Considering that there is now a global trend towards replacing expensive original drugs with generics, it is important to make a choice in favor of a product that optimally combines European quality, a favorable safety profile and an acceptable cost for the Ukrainian consumer. Sandoz generic medicines are the winners. Since October, the Ukrainian pharmaceutical market has received an attractive dosage form of azithromycin for pulmonologists, pediatricians and primary care physicians – Azitro Sandoz 500 mg, No. 6, which can provide additional benefits and make it more convenient to treat pneumonia on an outpatient basis (especially in cases where prolonged course of antibiotic therapy).