We have demonstrated a novel association between macrolide use and increased survival in patients with ALI (acute lung injury), the authors conclude. Further studies to investigate potential therapeutic benefits for macrolides in ALI are warranted.
The only treatment demonstrated to reduce mortality in acute lung injury is low tidal volume ventilation, but animal experiments have shown that the immunomodulatory effects of macrolides may be beneficial in this setting, note Dr. Allan J. Walkey and Dr. Renda S. Wiener at Boston University School of Medicine, Massachusetts.
To investigate further, they analyzed data on 235 ALI patients previously enrolled in the LARMA trial, which included detailed information on antibiotic use and timing. Macrolide antibiotics — erythromycin or azithromycin — were administered within 24 hours to 47 of the patients.
Mortality was 23% among those receiving macrolides compared with 36% in patients who did not receive a macrolide (p=0.11), the authors found.
The cause of ALI was more likely to be pneumonia in the macrolide group, while non-pulmonary sepsis and use of low volume ventilation was less likely. After adjustment for these and other potential confounders, the team calculated that macrolide use was associated with a lower 180-day mortality (hazard ratio 0.46; p=0.028) and faster discontinuation of mechanical ventilation (hazard ratio 1.93; p=0.009)
In contrast, fluoroquinolone (n=90) and cephalosporin antibiotics (n=93) were not associated with improved outcomes, Drs. Walkey and Wiener note.
In discussing the findings, they acknowledge that the dataset used for this study is now over 10 years old, and changes in practice patterns may have modified the potential benefits of macrolides. Nonetheless, they conclude, These findings suggest that macrolide antibiotics hold promise as a potential therapy early in the course of ALI.