Investigators discovered that low doses of the antibiotic azithromycin could halt and reverse lung function decline in the majority of 20 lung transplant patients who suffered from the deadly, previously untreatable condition Bronchiolitis Obliterans Syndrome (BOS). To date, the only way physicians have been able to manage this problem is by transplanting a new lung.
Lung transplant patients are considered to have BOS when they experience a persistent decline in lung function test results in the absence of acute rejection, infection, or bronchial complications.
Since BOS leads to deteriorating graft function with limited long-term survival, transplant physicians have tried using multiple strategies in an effort to manage the condition. None have worked.
At 5 years after lung transplantation, data from the International Transplant Registry shows the prevalence of BOS at 50 percent. As a result, 7-year mean survival has been limited to 31 percent.
Recently, several small pilot studies have stirred up interest in the role of macrolide antibiotics in the management of BOS. Macrolides are any of several antibiotics, including erythromycin, used as antibacterial agents. (Azithromycin is derived from erythromycin.)
According to the authors, after 3 months of azithromycin therapy of 250 mg every other day, patients showed a significant increase in lung function test results when they took a common lung function test, forced expiratory volume in one second. The increases average 110 ml with a range from -70 to 730 ml; the higher figure was seen in one patient.
The study appears in the second issue for September 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Failure to Follow Treatment Guidelines for Pneumonia Takes Toll
During a study at 13 hospitals of 1,288 patients with community-acquired pneumonia, research investigators found that treatment failure and mortality rates were much higher when Spanish physicians failed to follow the latest antibiotic treatment guidelines in their initial selection of the appropriate drug. The investigators noted that the right initial antibiotic is key to resolution of infection, and to a better patient prognosis.
According to the researchers, treatment difficulties might arise because community-acquired pneumonia can be caused by multiple organisms, which cannot be identified from clinical and radiographic findings. Also, conventional microbiological methods have limited ability to show when disease is present (sensitivity) and when it is absent (specificity).
The investigators indicated that evidence-based guidelines had been developed by scientific societies to assist physicians in the selection of antibiotics and to reduce variability in clinical care.
As shown in their study, the authors pointed out that the risk of death was 8.9 percent among patients of physicians who did not adhere to guidelines and 5.4 percent among patients of those who did not. Treatment failure was 19.7 percent for patients of doctors who did not follow guidelines and 12.9 percent among patients of those who did.
(During the study, a total of 175 patients experienced treatment failure, and a total of 74 patients died.)
The researchers said that patients who were mentally confused and had low blood pressure were treated more often with regimens that did not comply with guidelines.
In addition, the researchers revealed that adherence to guidelines differed greatly among the study hospitals, ranging from 47 to 97 percent.
Overall, 80 percent of the patients received initial antibiotic therapy based on guidelines upon admission to hospital wards, but only 67.4 percent were in compliance when treated in intensive care units.
The research appears in the second issue for September 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Brian Kell at 212-315-6442, or by e-mail at bkell@thoracic.org.
Journal
American Journal of Respiratory and Critical Care Medicine