Long-term use of antibiotics could reduce COPD exacerbations by 35 per cent, according to UK research.

But the benefits of long-term antibiotic use may have to be weighed up against the potential harm caused by antibiotic resistance.

For this latest study, the researchers followed up 109 patients with moderate to severe COPD - an FEV1 between 30 to 70 per cent - for one year.

The patients were randomly assigned to receive either a twice daily 250mg dose of erythromycin or placebo. Patients were asked to record their exacerbations and whether they had been hospitalised for their COPD.

They were also tested for lung function, bacterial infection and markers of inflammation such as C-reactive protein.

Overall, they found that patients in the erythromycin group experienced 35 per cent fewer exacerbations compared with those in the placebo group.

Although the number of patients who were hospitalised for their COPD was small, taking erythromycin halved the number of hospital-related exacerbations (six patients) compared with placebo (14).

Lead researcher Dr Jadwiga Wedzicha, from the unit of respiratory medicine at University College London, said the results showed a significant effect of low-dose macrolide therapy in reducing exacerbation frequency and severity in patients with moderate to severe COPD.

'There are a small number of severe COPD patients, who are on maximal therapy and still symptomatic and having frequent hospital admissions, with a poor quality of life.

'Some of these patients may be suitable for a trial with erythromycin and need referral for specialist assessment that will detect airway infection.'

sanjay.tanday@haymarket.com

• Am J Respir Crit Care Med 2008; 178: 1,139-47

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