Mayo Clinic: I have chronic obstructive pulmonary disease (COPD),
and my doctor is recommending an antibiotic drug long term.
Why is this needed?
certain people with COPD, long-term use of an antibiotic drug
— specifically azithromycin (Zithromax) — is a fairly new
option to reduce exacerbations. Exacerbations are episodes
when symptoms of COPD become worse than their usual day-to-day
variation. Some exacerbations may be caused by a viral or
bacterial infection. An exacerbation, if severe, can lead to
hospitalization and even respiratory failure and death.
people with COPD, short-term use of antimicrobials —
antibiotics and antiviral agents — can help fight
respiratory infections, such as acute bronchitis, pneumonia
and influenza, and be used as part of the treatment of an
exacerbation. A 2011 study indicated that long-term, continued
use of azithromycin helps prevent COPD exacerbations — even
for those who don’t have an active respiratory infection. In
addition to its antibacterial effects, azithromycin has
anti-inflammatory and immune-modulating effects that likely
contribute to its ability to improve COPD management.
study included people who had COPD with an increased risk of
exacerbations, most of whom already were taking other
medications to prevent exacerbations. Among those who took
azithromycin daily for a year, the risk of having an
exacerbation declined by about 27 percent, compared to those
who took an inactive substance (placebo).
are five classes of medications that may be used to help
prevent COPD exacerbations. The classes include the antibiotic
azithromycin. The other classes are inhaled corticosteroids,
long-acting beta agonists, long-acting muscarinic antagonists,
and phosphodiesterase-4 inhibitors. It’s common for more
than one of these to be used at the same time, and there are
multiple inhalers that combine two of these agents.
isn’t often the first drug prescribed for exacerbation
prevention, but it may have an important role for some people
potential side effect of long-term azithromycin is hearing
loss. In addition, people with a certain electrocardiogram
abnormality — a prolonged QT interval — shouldn’t take
azithromycin. Also, there appears to be a slightly increased
risk of death due to heart rhythm problems associated with use
of azithromycin. There also is controversy regarding the risk
of antibiotic-resistant bacteria with long-term use of