Epub 2013 Aug 22. Intermittent antibiotic use also reduced the number of exacerbations, but this result was not significant. Azithromycin was shown to have important effects on inflammatory cells, including improving phagocytic function of alveolar macrophages, up-regulation of the phosphatidylserine pathway, and increased expression of mannose receptors on alveolar macrophages. However, the appropriate antibiotic regimen and target population are unclear.A 2013 Cochrane review of seven RCTs (N = 3,170) examined whether the use of prophylactic antibiotics in patients with COPD reduces exacerbations or improves quality of life.A 2014 RCT compared pulsed prophylaxis with azithromycin (500 mg three times weekly for 12 months) with placebo in 92 adults with COPD who had at least three exacerbations in the preceding year.A 2015 RCT examined antibiotic prophylaxis with the macrolide roxithromycin (not available in the United States). On average, the … Antibiotics have previously demonstrated anti-inflammatory properties, and they have been linked to therapeutic benefit in several pulmonary conditions that feature inflammation. The use of clarithromycin in subjects with stable COPD was investigated by Banerjee et al,Roxithromycin is another 14-membered macrolide antibiotic. Two Australian retrospective case series of hospitalised COPD patients have found that antibiotic treatment was guideline concordant in less than 15% of cases (Brownridge 2017, Fanning 2014). Safety concerns regarding antibiotic resistance need to be addressed before widespread use in clinical practice.COPD is defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD)Chronic inflammation is key in the pathogenesis of COPD. Further research is warranted.Moxifloxacin is a fluoroquinolone antibiotic; its effect in subjects with stable COPD has been examined in 2 recent studies (These 2 studies are too small to draw reliable conclusions, and additional high-powered studies are necessary to determine whether pulsed moxifloxacin treatment can be of use in patients with stable COPD for exacerbation prevention.Finding a way to effectively manage the chronic inflammation in COPD may be key in reducing mortality and slowing disease progression. Epub 2014 May 11.Evid Based Med. Nine studies were of continuous antibiotics, two studies were of intermittent antibiotic prophylaxis and two were of pulsed antibiotics. This reduces the generalizability of the results because many patients with COPD have comorbidities, so care needs to be taken to restrict macrolide usage to suitable patients.In conclusion, this review supports the use of continuous low-dose azithromycin or erythromycin therapy to improve exacerbation-related COPD outcomes. Erythromycin failed to show a strong ability to inhibit cytokines and chemokines, which is not consistent with the results from the other macrolide antibiotics. There is no clear evidence of effect for the other antibiotics discussed, so no conclusions can be drawn. COREY D. FOGLEMAN, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, PennsylvaniaAuthor disclosure: No relevant financial affiliations.Can prophylactic antibiotics decrease chronic obstructive pulmonary disease (COPD) exacerbations in a 67-year-old man with a history of frequent exacerbations?Continuous prophylactic antibiotic therapy significantly decreases COPD exacerbations for up to three years. PMID: 31150175 No abstract available. This review assesses the potential benefit of prophylactic, long-term, and low-dose antibiotic therapy in COPD, and whether any effects seen are anti-inflammatory in nature. To ensure you stay up-to-date with these guidelines… Macrolides have been shown to accumulate in high concentrations in alveolar macrophages compared to other classes of antibiotics.Macrolides were also shown to have effects on transcriptional factors and mediator molecules. Further studies would be of use, particularly those examining other classes of antibiotics (eg, fluoroquinolones).Summary of Modulatory Effects of Antibiotics in COPDThe novel non-antibiotic macrolide CSY0073 had positive results and an anti-inflammatory profile similar to that of azithromycin. ATS/ERS Task Force for COPD Research. The study compared roxithromycin, 300 mg per day for 12 weeks; a combination of roxithromycin and doxycycline, 300/100 mg per day for 12 weeks; and placebo.A 2014 joint statement from the American Thoracic Society and the European Respiratory Society states that it is not clear which patients benefit from antibiotic prophylaxis for COPD exacerbations, and that the optimal dosing strategy and duration of use are unknown.Copyright © Family Physicians Inquiries Network. Shafuddin E, Poole P. et al. 25 Seven small studies that tested whether macrolides decrease the frequency of acute exacerbations of COPD reported conflicting results.26-32 Accordingly, we conducted a large, randomized trial to test the hypothesis that azithromycin decreases the frequency of acute exacerbations of COPD when added to the usual care of these patients. Mullins PR,