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Repost from Clinical Practice guidelines
๐ด Azithromycin and other long-term antibiotic therapy โ:
โ๏ธ Macrolide therapy is most likely to be helpful in๐ reducing COPD exacerbations in patients with bronchiectasis๐ recurrent bacterial pulmonary infections
๐ and those who are not actively smoking.
๐ค The benefit of macrolides in reducing COPD exacerbations is likely attributable to their๐๐ anti-inflammatory properties in addition๐ to their direct antimicrobial function.
โ Dosing and efficacy โ:
๐ We typically use azithromycin, 250 mg daily
๐ or 500 mg three times per week, which are the best-studied regimens and recommended by most international guidelines๐จ๐.
โ๏ธ However, some experts use a lower initial dose of๐๐ azithromycin 250 mg three times per week to
๐ reduce adverse effects
โ๏ธ๐ with an increase to 500 mg three times a week only if exacerbations persist and the lower dose is tolerated.
๐ด This approach is based on efficacy of the lower dose in bronchiectasis and pharmacokinetics which result in intracellular accumulation over time
๐but is less well-studied than the higher doses.
โ๏ธโ๏ธโ๏ธThe optimal duration of therapy is unclear
๐๐ but 12-month courses or longer are typical.
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