🔴 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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