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