What is the dose of Azithromycin (Azithro) for Chronic Obstructive Pulmonary Disease (COPD) exacerbation?

From the Guidelines

For COPD exacerbation, azithromycin should be dosed at 250 mg daily or 500 mg three times a week to reduce exacerbation rates, as recommended by the British Thoracic Society guideline 1. The dosing regimens with the greatest supportive evidence for reducing exacerbation rates are azithromycin 500 mg three times a week, azithromycin 250 mg daily, and erythromycin ethylsuccinate 400 mg twice a day 1. Some key points to consider when using azithromycin for COPD exacerbations include:

• The medication should be taken consistently, with or without food 1.
• Azithromycin works by inhibiting bacterial protein synthesis and has anti-inflammatory properties that may provide additional benefit in COPD 1.
• Patients should complete the full course even if symptoms improve before completion 1.
• Those with severe liver or kidney disease may require dose adjustments 1.
• Common side effects include nausea, diarrhea, and abdominal pain 1.
• Patients should be monitored for QT interval prolongation, especially if they have cardiac risk factors or are taking other medications that can prolong the QT interval 1. It is also important to note that long-term azithromycin therapy can reduce exacerbations over 1 year, but is associated with an increased incidence of bacterial resistance and hearing test impairment 1. When using macrolides to reduce exacerbation rates, therapy should be offered for a minimum of 6 months 1. Macrolides can be considered with the aim of improving quality of life, but may require a long period of therapy, such as 1 year, for significant effects 1.

From the FDA Drug Label

Acute bacterial exacerbations of chronic obstructive pulmonary disease (mild to moderate) 500 mg QD × 3 days OR 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 The recommended dose of Azithromycin for acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) is:

• 500 mg once daily for 3 days or
• 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 2

From the Research

Azithromycin Dose for COPD Exacerbation

• The recommended dose of azithromycin for COPD exacerbation is 250 mg daily 3, 4, 5.
• This dose has been shown to decrease the frequency of exacerbations in patients with COPD who have an increased risk of exacerbations 4.
• The use of azithromycin in COPD patients has been associated with a reduction in the number of exacerbations, improvement in quality of life, and a decrease in inflammatory markers 3, 4, 5.

Patient Selection

• Azithromycin is most effective in preventing COPD exacerbations requiring both antibiotic and steroid treatment 3.
• The treatment is more effective in older patients and those with milder Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 3.
• Current smokers may not benefit from azithromycin treatment, as it did not reduce exacerbations in this group 3.

Treatment Duration and Administration

• The optimal duration of azithromycin therapy for COPD exacerbation is not well established, but it has been studied for up to 1 year 4, 5.
• Azithromycin can be administered daily, with a dose of 250 mg or 500 mg daily, three times a week 5.