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The effects of azithromycin in treatment-resistant cough: A randomized, double-blind, placebo-controlled trial

Hodgson, David; Anderson, John; Reynolds, Catherine; Oborne, Janet; Meakin, Garry; Bailey, Helen; Shaw, Dominick E.; Mortimer, Kevin; Harrison, Tim

Authors

David Hodgson

John Anderson

Catherine Reynolds

Janet Oborne

Helen Bailey

Kevin Mortimer

TIM HARRISON tim.harrison@nottingham.ac.uk
Professor of Asthma and Respiratory Medicine



Abstract

Background

Chronic cough is a common clinical problem worldwide. Although many patients have underlying precipitating conditions such as asthma, gastroesophageal reflux, or rhinitis, many remain symptomatic despite treating these conditions. New approaches are needed for the treatment of this group of patients.

Methods

We conducted a randomized, double-blind, placebo-controlled trial to determine whether 250 mg of azithromycin three times a week for 8 weeks would affect the Leicester Cough Questionnaire (LCQ) score in 44 patients with treatment-resistant cough. Cough severity on a visual analog scale and bronchial exhaled nitric oxide were measured as secondary outcomes.

Results

There was a clinically important improvement in LCQ score with azithromycin (mean change, 2.4; 95% CI, 0.5 to 4.2) but not placebo (mean change, 0.7; 95% CI, −0.6 to 1.9), but the between-group difference was not statistically significant (P = .12). There were no significant between-group differences for any of the secondary outcome measures. Looking at subgroups of responders, there was a large and significant improvement in LCQ score in patients with chronic cough and a concurrent diagnosis of asthma who were treated with azithromycin (mean, 6.19; 95% CI, 4.06 to 8.32).

Conclusions

Treatment with low-dose azithromycin for 8 weeks did not significantly improve LCQ score compared with placebo. The use of macrolides for treatment-resistant cough cannot be recommended from this study, but they may have a place in the treatment of chronic cough associated with asthma; this is worthy of further investigation.

Citation

Hodgson, D., Anderson, J., Reynolds, C., Oborne, J., Meakin, G., Bailey, H., …Harrison, T. (2016). The effects of azithromycin in treatment-resistant cough: A randomized, double-blind, placebo-controlled trial. Chest, 149(4), 1052-1060. doi:10.1016/j.chest.2015.12.036

Journal Article Type Article
Acceptance Date Jan 20, 2016
Online Publication Date Jan 21, 2016
Publication Date Apr 30, 2016
Deposit Date May 9, 2017
Journal Chest
Print ISSN 0012-3692
Electronic ISSN 1931-3543
Publisher Elsevier
Peer Reviewed Not Peer Reviewed
Volume 149
Issue 4
Pages 1052-1060
DOI https://doi.org/10.1016/j.chest.2015.12.036
Keywords Airway inflammation; Antibiotic therapy; Cough
Public URL http://eprints.nottingham.ac.uk/id/eprint/42609
Publisher URL https://doi.org/10.1016/j.chest.2015.12.036