Chest
Original ResearchCritical CareMacrolide Antibiotics and Survival in Patients With Acute Lung Injury
Section snippets
Data Source
We used deidentified, open-access data from subjects previously enrolled in the ARDSNet LARMA trial, during which antibiotic type and timing was recorded in detail for all participants. Details of LARMA have been published previously.8 Briefly, participants were enrolled from 21 hospitals across the United States within 36 h of meeting ALI consensus criteria21 and were randomized via 2 × 2 factorial design to receive 6 mL or 12 mL/kg tidal volumes (as part of the Respiratory Management of ALI
Results
The characteristics of the 235 study participants stratified by macrolide exposure are shown in Table 1. Analogous results for fluoroquinolone use are shown in Table 2.
An antibiotic was administered to 232 of 235 trial participants (99%) within 24 h of enrollment. Macrolide antibiotics were used in 47 trial participants (20%). The most common macrolide received was erythromycin (n = 27, 57%), followed by azithromycin (n = 19, 40%); one participant received clarithromycin. The median duration of
Discussion
The analysis suggests an association between macrolide antibiotic use and improved outcomes in ALI. We observed increased survival and decreased time to successful discontinuation of mechanical ventilation associated with receipt of a macrolide early during the course of ALI. Our analyses did not demonstrate an association between fluoroquinolone or cephalosporin use and ALI survival. These findings suggest that macrolide antibiotics hold promise as a potential therapy early in the course of
Conclusions
In conclusion, this analysis suggests a novel association between macrolide use and increased survival in patients with ALI. Further studies to investigate potential therapeutic benefits for macrolides in ALI are warranted.
Acknowledgments
Author contributions: Dr Walkey had full access to the data and takes full responsibility for the contents of this manuscript.Dr Walkey: contributed to the study concept, statistical analyses, results interpretation, and drafting of the manuscript.Dr Wiener: contributed to the results interpretation and drafting of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or
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Cited by (0)
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).