Journal article

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Azithromycin during Acute COPD Exacerbations Requiring Hospitalization (BACE): a Multicentre, Randomized, Double-blind, Placebo-controlled Trial

Author(s): Vermeersch K,Gabrovska M , Aumann J et al on behalf of the BACE trial investigators

Am J Respir Crit Care Med. 2019 May 3. doi: 10.1164/rccm.201901-0094OC

Airway diseases
General respiratory patient care

Digest Author(s): Stylianos Loukides, e-Learning Director / 9 May, 2019

In this double- blind placebo-controlled trial the authors extended previous knowledge in the field by administering Azithromycin during and for three months after an AECOPD requiring hospitalization. The main outcome was treatment failure within three months. As treatment failure was defined as following: The composite of treatment intensification with medication [TI], step-up in hospital care or readmission for respiratory reasons [SH] or all-cause mortality. The study drug was administered on top of standard care [bronchodilators, antibiotics, systemic corticosteroids] at dose 500mg/day for 3 days and subsequently continued for three months at dose 250mg three times per week. The period of follow up was 6 months. 301 patients were randomized to either azithromycin [147] or placebo [154]. The main results showed lack of statistical significance in the whole treatment failure rate. However, TI and SH significantly differed between the two groups in favor of Azithromycin. No significant difference was observed in regard to mortality rates. The final conclusion was that 3m of azithromycin for AECOPD requiring hospitalization may significantly reduce TF in terms of both TI and SH during the highest risk period.

Comment

This well-designed study provided us with useful information in the clinical field. Adding azithromycin to standard care during an ECOPD, followed by lower dose for three months may show some benefits which are mainly related to the composite of treatment intensification with medication as well as to step-up in hospital care or readmission for respiratory reasons. Azithromycin exceeds its bacteriostatic role and provides a robust immunomodulatory effect in the ideal environment of COPD exacerbation.