Antibiotic azithromycin boosts lung function in young people with CF
Treatment improved breathing, slowed lung function decline in children, teens
Treatment with the antibiotic azithromycin improves breathing while slowing lung function decline over time in children and teens with cystic fibrosis (CF), according to a meta-analysis of published studies.
“These findings not only provide a new perspective for clinical treatment but also reveal potential mechanisms of azithromycin in the treatment of CF,” the researchers wrote. The review study, “The Impact of Azithromycin on Lung Function in Children And Adolescents with Cystic Fibrosis: A Systematic Review And Meta-Analysis,” was published in Clinical Therapeutics.
In CF, the abnormal build-up of thick, sticky mucus in the lungs creates a breeding ground for chronic bacterial infections. This can lead to irreversible lung damage and respiratory failure, severely impacting quality of life and life expectancy.
Antibiotics are typically prescribed to eliminate or control bacterial lung infections in CF. Azithromycin, in particular, has garnered attention for CF not only for its broad-spectrum antibacterial properties, but also for its anti-inflammatory effects.
Azithromycin’s promise in CF
Despite its promising benefits, published studies report varying results. Some short-term studies have shown significant gains in lung function with azithromycin, while data on its long-term effects, side effects, optimal dosage, and treatment duration remain limited.
To better understand its impact on lung function in children and teens with CF, researchers in China reviewed studies published up to November 2024 that reported on data from clinical trials. Eight trials, which randomly assigned 625 children and adolescents with CF to either azithromycin or a placebo, were analyzed.
Lung function was assessed by forced expiratory volume (FEV1), the amount of air a person can breathe out in one second, and forced vital capacity (FVC), the total amount of air exhaled after a deep breath.
According to the pooled results, children and adolescents who received azithromycin had significantly better lung function than the placebo group, as indicated by a higher FEV1. The overall effect remained robust after excluding individual studies, one at a time.
“The significant improvement in FEV1 caused by azithromycin has important clinical implications,” the researchers wrote. “FEV1, as a key indicator of lung function in CF patients, directly reflects airway [openness] and lung health status.”
Azithromycin was also associated with a trend toward improvements in lung function as assessed by FVC relative to the placebo, but the differences weren’t statistically significant. Although the results stayed stable after excluding individual studies, measures of variability between the study results depended on which one was excluded.
“In CF patients, long-term airway inflammation and mucus accumulation lead to significant structural damage in the lungs … which can affect FVC measurements,” the researchers wrote.
Pooled data also showed that over time, azithromycin reduced the risk of lung function decline by 21%, with low variability across the studies.
“Long-term use of azithromycin may mitigate sustained airway damage caused by repeated lung infections, enabling patients to maintain relatively better lung function,” the researchers wrote. “Azithromycin shows promise in improving FEV1 and slowing lung function decline in children with cystic fibrosis, supporting its potential role in clinical management.”
They said studies going forward “should focus on optimizing treatment regimens, clarifying long-term efficacy and safety, and evaluating combination strategies to enhance therapeutic outcomes.”
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