Prophylactic Azithromycin, Begun During a COPD Exacerbation, Might Be Beneficial

Prophylactic therapy with macrolide antibiotics — which have both antimicrobial and anti-inflammatory properties — modestly lowers the incidence of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). However, studies generally have been initiated when patients are clinically stable (NEJM JW Gen Med Sep 15 2011 and N Engl J Med 2011; 365:689). In this randomized trial that involved 301 patients hospitalized with COPD exacerbations (but not in the intensive care unit [ICU]), Belgian researchers initiated short-term prophylaxis during hospitalization.

Patients received 90-day courses of azithromycin (500 mg daily for 3 days, started early in the hospital stay, followed by 250 mg every other day) or placebo. All pa…