Intervention Review

Azithromycin for acute lower respiratory tract infections

  1. Malinee Laopaiboon1,*,
  2. Ratana Panpanich2,
  3. Peerasak Lerttrakarnnon3

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 7 AUG 2011

DOI: 10.1002/14651858.CD001954.pub3

Database Title

Additional Information

How to Cite

Laopaiboon M, Panpanich R, Lerttrakarnnon P. Azithromycin for acute lower respiratory tract infections. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001954. DOI: 10.1002/14651858.CD001954.pub3.

Author Information

  1. 1

    Khon Kaen University, Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen, Thailand

  2. 2

    Faculty of Medicine, Community Medicine, Chiang Mai, North, Thailand

  3. 3

    Faculty of Medicine, Chiang Mai University, Department of Family Medicine, Chiang Mai, Thailand

*Malinee Laopaiboon, Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand. malinee@kku.ac.th. laopaiboonmalinee@yahoo.co.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Acute lower respiratory tract infections (LRTI) range from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Approximately five million people die from acute respiratory tract infections annually. Among these, pneumonia represents the most frequent cause of mortality, hospitalisation and medical consultation. Azithromycin is a macrolide antibiotic, structurally modified from erythromycin and noted for its activity against some gram-negative organisms associated with respiratory tract infections, particularly Haemophilus influenzae (H. influenzae).

Objectives

To compare the effectiveness of azithromycin to amoxycillin or amoxycillin/clavulanic acid (amoxyclav) in the treatment of LRTI, in terms of clinical failure, incidence of adverse events and microbial eradication.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 3), MEDLINE (January 1966 to July week 4, 2011) and EMBASE (January 1974 to August 2011).

Selection criteria

Randomised controlled trials (RCTs) and quasi-RCTs, comparing azithromycin to amoxycillin or amoxycillin/clavulanic acid in participants with clinical evidence of an acute LRTI, such as acute bronchitis, pneumonia and acute exacerbation of chronic bronchitis.

Data collection and analysis

The review authors independently assessed all potential studies identified from the searches for methodological quality. We extracted and analysed relevant data separately. We resolved discrepancies through discussion. We initially pooled all types of acute LRTI in the meta-analyses. We investigated the heterogeneity of results using the forest plot and Chi2 test. We also used the index of the I2 statistic to measure inconsistent results among trials. We conducted subgroup and sensitivity analyses.

Main results

Sixteen trials involving 2648 participants were included. We were able to analyse 15 of the trials with 2496 participants. The pooled analysis of all the trials showed that there was no significant difference in the incidence of clinical failure on about days 10 to 14 between the two groups (risk ratio (RR), random-effects 1.09; 95% confidence interval (CI) 0.64 to 1.85). A subgroup analysis in trials with acute bronchitis participants showed significantly lower clinical failure in the azithromycin group compared to amoxycillin or amoxyclav (RR random-effects 0.63; 95% CI 0.45 to 0.88). A sensitivity analysis showed a non-significant reduction in clinical failure in azithromycin-treated participants (RR 0.55; 95% CI 0.25 to 1.21) in three adequately concealed studies, compared to RR 1.32; 95% CI 0.70 to 2.49 in 12 studies with inadequate concealment. Twelve trials reported the incidence of microbial eradication and there was no significant difference between the two groups (RR 0.95; 95% CI 0.87 to 1.03). The reduction of adverse events in the azithromycin group was RR 0.76 (95% CI 0.57 to 1.00).

Authors' conclusions

There is unclear evidence that azithromycin is superior to amoxycillin or amoxyclav in treating acute LRTI. In patients with acute bronchitis of a suspected bacterial cause, azithromycin tends to be more effective in terms of lower incidence of treatment failure and adverse events than amoxycillin or amoxyclav. However, most studies were of unclear methodological quality and small sample sizes; future trials of high methodological quality and adequate sizes are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Azithromycin for acute lower respiratory tract infections

Acute lower respiratory tract infections (LRTI) are one of the most common diagnoses in outpatient settings. They range from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Azithromycin is a subclass of macrolide antibiotics and is used to treat certain bacterial infections.

This review compared azithromycin with amoxycillin or amoxyclav in the treatment of acute LRTI in 16 trials. We were able to analyse the results from 15 trials with 2496 participants. The effects of azithromycin on cure, improvement or failure were not better than those of amoxycillin or amoxyclav. However, azithromycin seems to have a lower incidence of adverse events than amoxycillin or amoxyclav but it is not significant. Only three included trials showed adequate allocation concealment and most of the included trials were of unclear methodological quality with small sample sizes. We recommend future trials to be of good methodological quality and conducted on larger populations.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Azithromycin在急性下呼吸道感染的使用

急性下呼吸道感染的範圍包含急性支氣管炎、慢性支氣管炎急性發作以及肺炎。每年約有五百萬人死於急性呼吸道感染。在這當中，肺炎是造成死亡、住院以及醫療會診最常見的原因。Azithromycin是一種新的大環內酯類(Macrolide)抗生素，乃經由改造紅黴素(Erythromycin)的結構而來，對於對抗造成下呼吸道感染的革蘭氏陰性菌種，尤其是流感嗜血桿菌(Haemophilus influenzae)等特別有效。

目標

比較Azithromycin與Amoxycillin或Amoxycillin/clavulanic acid治療急性下呼吸道感染的功效，如臨床治療失敗率、副作用發生率以及細菌清除率等。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007 Issue 2)、MEDLINE (January 1966 to July 2007)，以及EMBASE (January 1974 to July 2007)等資料庫。

選擇標準

我們研究了比較Azithromycin與Amoxycillin或Amoxycillin/clavulanic acid，在急性下呼吸道感染(包含急性支氣管炎、肺炎以及慢性支氣管炎急性發作)病人身上治療效果的隨機與半隨機試驗。

資料收集與分析

評估研究品質的標準為：是否有分配序列(allocation sequence)、分配序列的隱匿、是否有障眼法(Blinding)，以及研究是否有做完全的完整性。所有種類的急性下呼吸道感染最初都匯集在整合分析(Metaanalyses)當中。我們以Forest plot以及Chisquare test來分析試驗結果的異質性(Heterogeneity)，同時也利用Isquare (I2)來衡量試驗之間的不一致性。最後還進行了子群體以及敏感度的分析。

主要結論

我們總共分析了15個試驗。匯集分析的結果顯示在最初的10到14天當中，兩組治療失敗的機率並無明顯的差異〔Relative risk(RR)隨機效應(Randomeffects)1.09，95% confidence interval(CI)0.64 – 1.85〕。以敏感度分析三個隱蔽的研究結果顯示，以Azithromycin治療的組別有較低的治療失敗率(RR 0.55，95% CI 0.25 – 1.21)，但其他12個不完全隱蔽的研究分析起來則無此現象(RR 1.32，95% CI 0.70 – 2.49)。有12個研究顯示兩組在病菌根除率上並無差異(RR 0.95，95% CI 0.87 – 1.03)。使用Azithromycin的組別降低副作用的RR為0.76(95% CI 0.57 – 1.00)。

作者結論

臨床上並無確切的證據證明使用Azithromycin治療急性下呼吸道感染的效果，是否優於使用Amoxycillin或Amoxycillin/clavulanic acid。但對於可能是細菌引起的急性支氣管炎來說，使用Azithromycin治療有較低的治療失敗率及較少的副作用。我們還需要更高品質的研究計畫來證實這些數據。

翻譯人

本摘要由慈濟醫院鄭育容翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在急性下呼吸道的治療中，Azithromycin並未優於Amoxycillin或Amoxycillin/clavulanic acid。急性下呼吸道感染是門診常見的診斷。一般來說，急性下呼吸道感染的病患常常以輕度至重度不等的咳嗽及發燒來表現，若懷疑為細菌引發的感染時就會考慮抗生素治療。這篇回顧文章檢驗了比較Azithromycin與Amoxycillin，或Amoxycillin/clavulanic acid在急性下呼吸道感染療效的研究。我們發現使用Azithromycin的治療無論在治癒率、臨床進步程度或治療失敗上並無較為優異的表現。

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