Nicholson T T, Franciosi A, Landers S, Butler M W
Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland.
Ir J Med Sci. 2016 Nov;185(4):993-997. doi: 10.1007/s11845-015-1372-8. Epub 2015 Oct 26.
Long-term daily azithromycin therapy reduces the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) in a randomized controlled clinical trial setting. Concerns exist regarding arrhythmic and auditory toxicities from chronic use in the real-world setting. We hypothesized that risk factors for adverse drug reactions to azithromycin would be more frequent than previously reported, that certain specific subgroups would have different frequencies of these risk factors and that the whispered voice test would be a useful test with which to test for hearing deficits.
Following ethical approval, 47 consecutive hospital-based patients with a mean age 69 years ± 8.2, and with physician-diagnosed COPD (mean FEV 45.1 ± 18 % predicted), were screened for subjective hearing impairment (screening questions and whispered voice test) and by electrocardiogram for prolonged QTc. Other potential risk factors and contraindications to long-term daily azithromycin were sought.
In total, 38 patients (80.9 %) had at least one risk factor or contraindication to azithromycin treatment. 19 patients (40.4 % of total) had subjective hearing impairment. 17 (36.1 %) had prolonged QTc intervals. 4 patients (8.51 %) had contraindicating co-morbidities. Those on long-term oxygen therapy were significantly more likely to have at least one risk factors or contraindications to azithromycin (p = 0.0025).
In a COPD population who would otherwise potentially be candidates for long-term daily azithromycin therapy, over 80 % had risk factors for complications from long-term daily azithromycin. Preventative treatment with long-term daily azithromycin may be appropriate for fewer COPD patients than previously thought, especially in those on long-term oxygen therapy.
在一项随机对照临床试验中，长期每日服用阿奇霉素可降低慢性阻塞性肺疾病（COPD）的急性加重频率。在现实环境中，长期使用阿奇霉素会引发心律失常和听觉毒性，这引发了人们的担忧。我们推测，阿奇霉素药物不良反应的风险因素比先前报道的更为常见，某些特定亚组的这些风险因素频率不同，并且耳语试验将是检测听力缺陷的有用测试。
经伦理批准后，对47例连续入院的患者进行筛查，这些患者平均年龄69岁±8.2岁，经医生诊断为COPD（平均FEV为预测值的45.1%±18%），通过主观听力障碍筛查（筛查问题和耳语试验）以及心电图检查QTc是否延长。还寻找了长期每日服用阿奇霉素的其他潜在风险因素和禁忌证。
共有38例患者（80.9%）至少有一项阿奇霉素治疗的风险因素或禁忌证。19例患者（占总数的40.4%）有主观听力障碍。17例（36.1%）QTc间期延长。4例患者（8.51%）有禁忌的合并症。长期接受氧疗的患者出现至少一项阿奇霉素风险因素或禁忌证的可能性显著更高（p = 0.0025）。
在原本可能适合长期每日服用阿奇霉素治疗的COPD人群中，超过80%的患者存在长期每日服用阿奇霉素引发并发症的风险因素。长期每日服用阿奇霉素进行预防性治疗可能适用于的COPD患者比之前认为的要少，尤其是那些长期接受氧疗的患者。
