Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;6(2):24.
doi: 10.21037/atm.2017.12.25.

Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients

Fabienne D Simonis  1   2 , Gianfranco de Iudicibus  3 , Olaf L Cremer  4 , David S Y Ong  4   5 , Tom van der Poll  6   7 , Lieuwe D Bos  1   2   8 , Marcus J Schultz  1   2   9 ; MARS consortium
Affiliations

Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients

Fabienne D Simonis et al. Ann Transl Med. 2018 Jan.

Abstract

Background: Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS).

Methods: This was an unplanned secondary analysis of patients with ARDS within a large prospective observational study of critically ill patients in the intensive care units (ICUs) of two university-affiliated hospitals in the Netherlands. The exposure of interest was low-dose macrolide use prescribed for another reason than infection; we excluded patients who received high-dose macrolides for an infection. The primary endpoint was 30-day mortality. The association between macrolide therapy and mortality was determined in the whole cohort, as well as in a propensity score matched cohort; the association was compared between pulmonary versus non-pulmonary ARDS, and between two biological phenotypes based on plasma levels of 20 biomarkers.

Results: In total, 873 patients with ARDS were analyzed, of whom 158 patients (18%) received macrolide therapy during stay in ICU for a median duration of 3 (interquartile range, 1-4) days. Erythromycin was the most frequent prescribed macrolide (97%). Macrolide therapy was associated with reduced 30-day mortality in the whole cohort [22.8% vs. 31.6%; crude odds ratio (OR), 0.64 (interquartile range, 0.43-0.96), P=0.03]. The association in the propensity score matched cohort remained significant [22.8% vs. 32.9%; OR, 0.62 (interquartile range, 0.39-0.96), P=0.03]. Propensity matched associations with mortality were different in patients with non-pulmonary ARDS vs. pulmonary ARDS and also varied by biological phenotype.

Conclusions: These data together show that low-dose macrolide therapy prescribed for another reason than infection is associated with decreased mortality in patients with ARDS.

Keywords: Acute respiratory distress syndrome (ARDS); erythromycin; macrolide; mortality; phenotypes; propensity score.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
CONSORT diagram. ARDS, acute respiratory distress syndrome.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kadota J, Mukae H, Ishii H, et al. Long--term efficacy and safety of clarithromycin treatment in patients with diffuse panbronchiolitis. Respir Med 2003;97:844-50. 10.1016/S0954-6111(03)00042-8 - DOI - PubMed
    1. Yamamoto M, Kondo A, Tamura M, et al. Long--term therapeutic effects of erythromycin and newquinolone antibacterial agents on diffuse panbronchiolitis. Nihon Kyobu Shikkan Gakkai Zasshi 1990;28:1305-13. - PubMed
    1. Nagai H, Shishido H, Yoneda R, et al. Long--term low--dose administration of erythromycin to patients with diffuse panbronchiolitis. Respiration 1991;58:145-9. 10.1159/000195915 - DOI - PubMed
    1. Kudoh S, Uetake T, Hagiwara K, et al. Clinical effects of low--dose long--term erythromycin chemotherapy on diffuse panbronchiolitis. Nihon Kyobu Shikkan Gakkai Zasshi 1987;25:632-42. - PubMed
    1. Wolter J, Seeney S, Bell S, et al. Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial. Thorax 2002;57:212-6. 10.1136/thorax.57.3.212 - DOI - PMC - PubMed

LinkOut - more resources