Long term antibiotics

Respiratory : Quality prescribing strategy - a guide for improvement
Scottish Government Effective Prescribing & Therapeutics Division
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  • Azithromycin 250mg three times a week is recommended for patients with four or more exacerbations in any 12-month period, after advice from secondary care. It has the most evidence base. Patients should be made aware of the potential adverse effects:

    • tinnitus and hearing loss (which can be reversed if treatment is stopped early)

    • prolongation of QTc interval and consequent increased risk of ventricular tachycardia

    • anti-microbial resistance

 

  • Prior to commencing azithromycin:
    • a mycobacterial culture of at least six weeks should be negative
    • an ECG should be performed to ensure a normal QTc
    • a medication check should be carried out to consider interactions, particularly with other medications that may prolong the QTc interval
    • Liver function tests with six monthly monitoring is recommended.

 

  • Azithromycin should be continued during exacerbations requiring antibiotics, except when receiving quinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin) in which case the azithromycin should be stopped due to risk of QTc prolongation. Azithromycin is less beneficial in active smokers.47
  • Clarithromycin 250mg daily can be used as an alternative macrolide for long term prophylaxis of exacerbations.
  • Doxycycline 100mg daily can be used as an alternative in patients who cannot tolerate, or are not suitable for, long term macrolide therapy.
  • Check local formulary guidance for area specific recommendations.