Cystic fibrosis: long-term azithromycin

Abstract

A Cochrane review (10 studies, n=959) assessed the use of long-term azithromycin for cystic fibrosis. Six studies (n=836) had a low risk of bias. Various dosing regimens were used, the most common being 250−500 mg 3 times weekly. In 4 studies (n=549), treatment with azithromycin statistically significantly improved forced expired volume in 1 second (FEV 1 ; the primary outcome) over 6 months compared with placebo. Azithromycin doubled the rate of being free of exacerbations over 6 months compared with placebo; however, the data were heterogeneous and should be interpreted with caution. The need for oral antibiotics was statistically significantly reduced with azithromycin, but there were limited data on the need for intravenous antibiotics and other secondary outcomes. Adverse events were uncommon and not obviously associated with azithromycin. There is little published evidence to determine the safety of azithromycin when used for over 6 months. Regulatory status: Regulatory status: Off-label. The topic was prioritised because there is uncertainty about the balance of risks and benefits when azithromycin is used long-term for cystic fibrosis.