Ramos Frederick L, Criner Gerard J
Temple University Hospital, Philadelphia, USA.
Curr Opin Pulm Med. 2014 Mar;20(2):153-8. doi: 10.1097/MCP.0000000000000028.
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with adverse outcomes and thus prevention of exacerbations is crucial. New data attest that long-term macrolide therapy decreases the risk of COPD exacerbations. We review the key studies that analyzed the effect of long-term use of macrolide antibiotics on the prevention of exacerbations, focusing on the higher quality evidence. Health-related quality of life, sputum bacteriology and development of resistance, inflammatory markers, lung function, cost-benefit analysis, and lung function in relation to long-term macrolide therapy are also discussed.
Two well designed, randomized, placebo-controlled trials report that select patients treated for 1 year with erythromycin or azithromycin, in addition to usual care, have prolonged time to and lower frequency of COPD exacerbations. There are more hearing decrements and higher prevalence of macrolide-resistant bacteria among the patients treated with macrolide therapy.
Prevention of COPD exacerbations is paramount given the adverse consequences on quality of life, lung function, and survival. Macrolide therapy for 1 year, in addition to usual therapy, decreases the risk of COPD exacerbations but carries the risk of hearing decrements and development of macrolide-resistant bacteria.
慢性阻塞性肺疾病（COPD）急性加重与不良后果相关，因此预防急性加重至关重要。新数据证明长期大环内酯类药物治疗可降低COPD急性加重的风险。我们回顾了分析长期使用大环内酯类抗生素预防急性加重效果的关键研究，重点关注更高质量的证据。还讨论了与长期大环内酯类药物治疗相关的健康相关生活质量、痰液细菌学及耐药性发展、炎症标志物、肺功能、成本效益分析和肺功能。
两项设计良好的随机安慰剂对照试验报告称，除常规治疗外，选择接受红霉素或阿奇霉素治疗1年的患者，COPD急性加重的时间延长且频率降低。接受大环内酯类药物治疗的患者中听力减退更多，大环内酯类耐药菌的患病率更高。
鉴于对生活质量、肺功能和生存的不良后果，预防COPD急性加重至关重要。除常规治疗外，大环内酯类药物治疗1年可降低COPD急性加重的风险，但存在听力减退和大环内酯类耐药菌产生的风险。
