Testing the effects of combining azithromycin with inhaled tobramycin for P. aeruginosa in cystic fibrosis: a randomised, controlled clinical trial

RationaleInhaled tobramycin and oral azithromycin are common chronic therapies in people with cystic fibrosis and Pseudomonas aeruginosa airway infection. Some studies have shown that azithromycin can reduce the ability of tobramycin to kill P. aeruginosa. This trial was done to test the effects of combining azithromycin with inhaled tobramycin on clinical and microbiological outcomes in people already using inhaled tobramycin. We theorised that those randomised to placebo (no azithromycin) would have greater improvement in forced expiratory volume in one second (FEV1) and greater reduction in P. aeruginosa sputum in response to tobramycin.MethodsA 6-week prospective, randomised, placebo-controlled, double-blind trial testing oral azithromycin versus placebo combined with clinically prescribed inhaled tobramycin in individuals with cystic fibrosis and P. aeruginosa airway infection.ResultsOver a 6-week period, including 4 weeks of inhaled tobramycin, the relative change in FEV1 did not statistically significantly differ between groups (azithromycin (n=56) minus placebo (n=52) difference: 3.44%; 95% CI: −0.48 to 7.35; p=0.085). Differences in secondary clinical outcomes, including patient-reported symptom scores, weight and need for additional antibiotics, did not significantly differ. Among the 29 azithromycin and 35 placebo participants providing paired sputum samples, the 6-week change in P. aeruginosa density differed in favour of the placebo group (difference: 0.75 log10 CFU/mL; 95% CI: 0.03 to 1.47; p=0.043).ConclusionsDespite having greater reduction in P. aeruginosa density in participants able to provide sputum samples, participants randomised to placebo with inhaled tobramycin did not experience significantly greater improvements in lung function or other clinical outcomes compared with those randomised to azithromycin with tobramycin.

Effect of a single dose of oral azithromycin on malaria parasitaemia in children: a randomized controlled trial

Background Azithromycin has recently been shown to reduce all-cause childhood mortality in sub-Saharan Africa. One potential mechanism of this effect is via the anti-malarial effect of azithromycin, which may help treat or prevent malaria infection. This study evaluated short- and longer-term effects of azithromycin on malaria outcomes in children. Methods Children aged 8 days to 59 months were randomized in a 1:1 fashion to a single oral dose of azithromycin (20 mg/kg) or matching placebo. Children were evaluated for malaria via thin and thick smear and rapid diagnostic test (for those with tympanic temperature ≥ 37.5 °C) at baseline and 14 days and 6 months after treatment. Malaria outcomes in children receiving azithromycin versus placebo were compared at each follow-up timepoint separately. Results Of 450 children enrolled, 230 were randomized to azithromycin and 220 to placebo. Children were a median of 26 months and 51% were female, and 17% were positive for malaria parasitaemia at baseline. There was no evidence of a difference in malaria parasitaemia at 14 days or 6 months after treatment. In the azithromycin arm, 20% of children were positive for parasitaemia at 14 days compared to 17% in the placebo arm (P = 0.43) and 7.6% vs. 5.6% in the azithromycin compared to placebo arms at 6 months (P = 0.47). Conclusions Azithromycin did not affect malaria outcomes in this study, possibly due to the individually randomized nature of the trial. Trial registration This study is registered at clinicaltrials.gov (NCT03676751; registered 19 September 2018).

Efficacy of Oral Azithromycin versus Doxycycline in the Treatment of Acne Vulgaris

Introduction: Acne vulgaris is one of the most common skin disease affecting adolescence of either sex, globally. Antibiotics like macrolides and tetracycline have been used with good results, studies comparing their efficacy are lacking. The present study compare the efficacy of Azithromycin v/s Doxycycline in acne vulgaris. Aims: To compare the efficacy of Azithromycin and Doxycycline in the treatment of acne vulgaris. Methods: This is a prospective hospital based comparative study, conducted on 80 patients attending outpatient department of Dermatology, Nepalgunj Medical College Teaching Hospital with acne vulgaris from July 2019 to April 2020. Patient were divided alternately into two groups, Group A received Azithromycin (n=40) and Group B Doxycycline (n=40) and compared the effects of treatment at 6 and 12 weeks. Efficacy assessment was done according to simple acne grading system. Results: Acne was predominant in female (62.5%) as compared to male (37.5%). Patient between 16 to 20 years age group were more prone to acne (47.5%). Most of the patients had Grade II acne before treatment in both groups (Azithromycin 52.5%, Doxycycline 55%). After the treatment most of them improve to Grade I at 6 weeks (Azithromycin 50%, Doxycycline 55%) and to Grade zero at 12 weeks (Azithromycin 42.5%, Doxycycline 67.5%).There was no statistically significant difference in treatment efficacy between the two groups at 6 weeks but at 12 weeks efficacy of Doxycycline was significantly better than Azithromycin. Conclusion: Both oral Azithromycin and Doxycycline when given for treatment of acne vulgaris the analysis showed good improvement after 6 weeks of treatment but there was no statistically significant difference in the improvement in both groups (p 0.771). However after 12 weeks patient receiving Doxycycline showed statistically significant improvement (p 0.035) in comparison to the patients receiving Azithromycin.

Long term oral azithromycin versus functional endoscopic sinus surgery in patients suffering from chronic rhinosinusitis: a comparative study

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal cavity and paranasal sinuses. Azithromycin, a macrolide antibiotic, a well-established class of anti-bacterial agents, which also have anti-inflammatory properties. The present study was designed to compare the role of azithromycin with surgical management in patients with chronic-rhinosinusitis.</p><p class="abstract"><strong>Methods: </strong>The study population included 60 adult patients with symptomatic CRS refractory to 3 weeks of medical therapy. The patients were divided in two groups with 30 patients in each group. One group of patients received oral Azithromycin as main treatment for 12 weeks while the other group of patients underwent sinonasal surgery. Symptom scoring and endoscopic scoring were done previous to the treatment and at 1 month and 3-month follow-ups.</p><p class="abstract"><strong>Results:</strong> A good subjective as well as objective outcome in terms of symptom improvement was obtained with in patients with chronic rhinosinusitis with Surgical intervention as compared to those patients who received long term oral Azithromycin.</p><p class="abstract"><strong>Conclusions: </strong>We advocate that patients suffering from chronic sinonasal disease should be initially targeted with maximal medical therapy using an oral macrolide for at least 3 months. After this patient should be assessed and surgery considered in those cases refractory to medical therapy.</p>

Comparing the efficacy of intense pulsed light combined with oral azithromycin versus oral azithromycin alone in the treatment of moderate to severe papulopustular acne vulgaris

Background: Rising follicular keratin secretion, increasing sebum production, and Propionibacterium acnes are among the main etiology of acne vulgaris formation. Antibiotics are the predominant conventional treatment of acne. Antibiotic resistance is the main problem in the ordinary treatments of acne. Therefore, newer treatments are necessary. Intense pulsed light (IPL) is a novel therapeutic option with rapid application in this field. Methods: Patients referred to us were randomized into two groups: group A (cases) and group B (controls). In addition to conventional antibiotic therapy, IPL was prescribed to group A while azithromycin alone was prescribed to group B. IPL treatment was performed weekly for five weeks and the patients were followed for three months. Declining inflammatory lesions count after the intervention was considered the remission scale. Results: In group A, moderate, partial, and complete remission occurred in 4, 9, and 7 patients, respectively. In group B, moderate, partial, and complete remission occurred in 10, 7, and 3 patients, respectively. Statistically, the remission difference was meaningful between the two groups. Conclusion: IPL with conventional antibiotics is an effective treatment choice in moderate to severe acne vulgaris but also is a more accelerating agent in treatment versus antibiotics alone.