0
Original Research: CRITICAL CARE |

Macrolide Antibiotics and Survival in Patients With Acute Lung InjuryMacrolides and Acute Lung Injury

Allan J. Walkey, MD; Renda S. Wiener, MD, MPH
Author and Funding Information

From Boston University School of Medicine (Drs Walkey and Wiener), The Pulmonary Center, Boston, MA; the Center for Health Quality, Outcomes, and Economic Research (Dr Wiener), Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; and The Dartmouth Institute for Health Policy and Clinical Practice (Dr Wiener), Dartmouth Medical School, Hanover, NH.

Correspondence to: Allan J. Walkey, MD, Boston University School of Medicine, The Pulmonary Center, 715 Albany St, R-304, Boston, MA 02118; e-mail: alwalkey@bu.edu


For editorial comment see page 1131

Funding/Support: Dr Wiener is supported by a career development award through the National Cancer Institute [K07 CA138772] and by the Department of Veterans Affairs.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1153-1159. doi:10.1378/chest.11-1908
Text Size: A A A
Published online

Background:  Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value for patients with acute lung injury (ALI). We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with ALI.

Methods:  Secondary analysis of multicenter, randomized controlled trial data from the Acute Respiratory Distress Syndrome Network Lisofylline and Respiratory Management of Acute Lung Injury Trial, which collected detailed data regarding antibiotic use among participants with ALI.

Results:  Forty-seven of 235 participants (20%) received a macrolide antibiotic within 24 h of trial enrollment. Among patients who received a macrolide, erythromycin was the most common (57%), followed by azithromycin (40%). The median duration of macrolide use after study enrollment was 4 days (interquartile range, 2-8 days). Eleven of the 47 (23%) patients who received macrolides died, compared with 67 of the 188 (36%) who did not receive a macrolide (P = .11). Participants administered macrolides were more likely to have pneumonia as an ALI risk factor, were less likely to have nonpulmonary sepsis or to be randomized to low tidal volume ventilation, and had a shorter length of stay prior to trial enrollment. After adjusting for potentially confounding covariates, use of macrolide was associated with lower 180-day mortality (hazard ratio [HR], 0.46; 95% CI, 0.23-0.92; P = .028) and shorter time to successful discontinuation of mechanical ventilation (HR, 1.93; 95% CI, 1.18-3.17; P = .009). In contrast, fluoroquinolone (n = 90) and cephalosporin antibiotics (n = 93) were not associated with improved outcomes.

Conclusions:  Receipt of macrolide antibiotics was associated with improved outcomes in patients with ALI.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Antibiotics for Bacteremic Pneumonia*: Improved Outcomes With Macrolides but Not Fluoroquinolones
PubMed Articles
Guidelines
Antibiotic therapy in preterm premature rupture of the membranes.
Society of Obstetricians and Gynaecologists of Canada | 9/29/2006
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543