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Permanent antibiotic therapy with azithromycin

are there any new recommendations concerning a permanent antibiotic therapy with azithromycin?
antibiotic therapy is one of the most important therapeutic measures in case of CF, in here long-term therapy with azithromycin in case of patients over 6 years of age, plays a central role. This therapy has many positive effects especially with chronic infection of Pseudomonas, it improves i.a. the lung function and reduces the exacerbation rate.
The suspicion, that it could reduce the efficacy of a simultaneously done therapy with inhalative tobramycin has been confirmed by a study from 2017, so that this combination is at least for some patients definitively not an optimal therapy.
Latest data prove, that in the first year of a long-term therapy with azithromycin, this is efficient, the long-term effects are discussed controversially. There are again and again concerns concerning the occurrence of new pulmonary germs induced by this therapy.
In a very recent data analysis from the American patient registry (Ann Am Thorac Soc. Feb 2018) it has been investigated, if the chronic therapy with azithromycin (defined as given 3 times a week) leads more often to the finding of specific pulmonary germs. In the mostly pediatric group of patients (median age was 12), it could habe been shown, that the patients had a decreased risk, to get CF specific germs (clearly reduced for MRSA, NTM, Burkholderia cepaic complex, in case of 5 other germs not significantly reduced). The authors concluded that with that data the concerns about new pulmonary germs due to azithromycin long-term therapy are not justified. These data however gives no informatin about older patients or patients, who do this therapy longer than 5 years.
Best regards,
Dr. H. Ellemunter