Azithromycin: More than just an antibiotic for COPD patients

Photo Credit: Blend Images/Terry Vine.

Most patients with COPD are no stranger to antibiotic therapy.   COPD is characterized by frequent exacerbations, often characterized by cough, mucus production, shortness of breath, and/or wheezing.  When these exacerbations occur, clinicians prescribe antibiotics in addition to traditional inhalers.  For the most part, exacerbations are treated with antibiotics such as macrolides (e.g. azithromycin), fluoroquinolones (e.g. levofloxacin, ciprofloxacin, moxifloxacin or others) or other types of antibiotics.

  The duration and choice of antibiotics may vary based on the patient, situation, or the health-care provider’s preference.  To treat an exacerbation, and ‘kill’ the bacteria causing the infection, antibiotics may be prescribed for short courses (usually 5 days) or longer courses (7-21 days).  

More recently, research has shown that a particular antibiotic, called azithromycin, may have benefits for patients with COPD beyond killing bacteria when taken routinely, as opposed to being used only during an exacerbation.  In addition to treating infections, azithromycin has anti-inflammatory action which provides benefit for patients who have recurrent COPD exacerbations (at least two per year.)  Since inflammation of the airways is one of the reasons why patients with COPD experience airflow obstruction and shortness of breath, it is not surprising that azithromycin therapy may help reduce the number of exacerbations that patients with COPD experience.

  In a study published in the New England Journal of Medicine in 2012, researchers found that patients who were treated with low dose azithromycin (250mg per day) had less exacerbations than those who took a placebo pill.  In addition, patients had better scores on the St. George’s Respiratory Questionnaire, which indicates less symptom burden.

  Although side effects were rare, some patients who took azithromycin experienced hearing problems and had higher rates of resistant bacteria in their airways (although this did not lead to clinical infection).

It is important to remember that routine, daily low-dose azithromycin therapy, however, is not for everyone, and should be prescribed by a health-care provider who is experienced in treating COPD, such as a pulmonologist.   In addition, traditional COPD medications (such as inhalers) should be maintained while taking azithromycin.  Patients who might be candidates for daily azithromycin therapy should have the proper screening before starting this medication on a daily basis.  Screening tests include hearing tests, electrocardiogram (EKG), liver function tests and a full history and physical exam.  

The Bottom Line:

For patients who have frequent COPD exacerbations, using daily low-dose azithromycin may help reduce exacerbation frequency and improve symptoms associated with COPD.  The proper screening and advice of a healthcare professional is critical, however, to identify those who might benefit from this treatment.



Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011;365:689-98.

Wenzel RP, Fowler AA, 3rd, Edmond MB. Antibiotic prevention of acute exacerbations of COPD. N Engl J Med 2012;367:340-7.

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