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Published ahead of print on April 2, 2003, doi:10.1164/rccm.200212-1424BC

Am. J. Respir. Crit. Care Med., Volume 168, Number 1, July 2003, 121-125

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Submitted on December 6, 2002
Accepted on March 28, 2003

Maintenance Azithromycin Therapy for Bronchiolitis Obliterans Syndrome: Results of a Pilot Study

Susan G Gerhardt1, John F McDyer1, Reda E Girgis1, John V Conte2, Stephen C Yang3, and Jonathan B Orens1*

1 Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Division of Thoracic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

* To whom correspondence should be addressed. E-mail: jorens{at}jhmi.edu.

Bronchiolitis obliterans syndrome remains the leading cause of morbidity and mortality in the pulmonary transplant population. Previous studies show that macrolide antibiotics may be efficacious in the treatment of panbronchiolitis and cystic fibrosis. In the later, azithromycin decreases the number of respiratory exacerbations, improves forced expiratory volume in one second, and improves quality of life. We hypothesized that oral azithromycin therapy may improve lung function in patients with bronchiolitis obliterans syndrome. To test this hypothesis, we conducted an open label pilot trial using maintenance azithromycin therapy in six lung transplant recipients (250 milligrams orally three times per week for a mean of 13.7 weeks). In this study, five of these six individuals demonstrated significant improvement in pulmonary function as assessed by forced expiratory volume in one second (FEV1), as compared to their baseline values at the start of azithromycin therapy. The mean increase in the percent of predicted FEV1 values in these individuals was 17.1% (p <= 0.05). Additionally, the absolute FEV1 increased by 0.50 liters (range -0.18 liters to 1.36 liters). These data suggest a potential role for maintenance macrolide therapy in the treatment of bronchiolitis obliterans syndrome in lung transplant recipients.
Key words: obliterative bronchiolitis, chronic rejection, macrolides, lung transplant




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