Azithromycin in the treatment of patients with exacerbation of chronic obstructive pulmonary disease.

The beneficial effects of low dose azithromycin on reducing the number of exacerbations in patients with chronic obstructive pulmonary disease (COPD) have been the subject of many clinical studies. Long-term administration of low dose azithromycin is known to suppress proinflammatory cytokine production, potentiate macrophage phagocytosis and anti-inflammatory cytokine expression. The effect of azithromycin is also associated with a decrease in the expression of human HLA (human leukocyte antigen) complex molecules in the respiratory tract, including HLA-A, HLA-B, HLA-DPA1, HLA-DRA, HLA-DRB4. In contrast, inhibition of viral infections by azithromycin is caused by a suppressive effect on the production of viral interferon. In the COLUMBUS study conducted in 92 COPD patients with frequent exacerbations who were given azithromycin for a year, inflammatory markers, eosinophilia, and GOLD severity were analyzed. It was found that the antibiotic therapy was most effective in patients with COPD with frequent exacerbations in GOLD 1 and 2 and GOLD C, as well as in patients with blood eosinophilia over 2%. An analysis of the costs of prophylactic administration of chronic azithromycin in patients with COPD in Belgium showed that the cost would be EUR 595 million, saving EUR 950 million for the treatment of COPD exacerbations. According to the recommendations in GOLD2020, azithromycin (250 mg or 500 mg daily three times a week) for 1 year in COPD patients significantly reduces the number of exacerbations.