**Author details**

has examined the effect of clarithromycin treatment in COPD [136]. This was a prospective double-blind randomized controlled trial of 67 patients with moderately severe COPD. The effects of 3 months' clarithromycin therapy on health status, exacerbation rate and sputum bacterial numbers were measured. Overall, no significant benefit was seen in any measure. However, significant improvements in both the SGRQ symptom score and 36-item short-form health survey (SF-36) physical function score were seen. A Japanese study performed in 1997 investigated the effect of long-term erythromycin therapy on common colds in patients with COPD [113]. It was a prospective, randomized, controlled but not blinded study. Patients who received erythromycin therapy had less common colds and less subsequent AECOPD compared to patients in the control group. In 2006, another study had been performed in the UK to investigate the influence of erythromycin on exacerbation of COPD [137]. Unfortunately, the total number of patients needed for inclusion was not reached. Although the study showed a significant reduction in number of exacerbations in COPD patients who received 1 year daily erythromycin, the reached conclusions should be carefully interpreted. The most recent study published concerning long term macrolide therapy in COPD was performed in the USA with over 1,000 patients. It showed a reduction in time to first exacerbation and a reduced risk for exacerbations in patients receiving daily azithromycin during 1 year [138]. The study partici‐ pants were patients who had at least 1 treated exacerbation in the previous year or who were on continuous supplemental oxygen or had an emergency department (ED) visit or hospital admission for an exacerbation COPD. The applicability of these results is somewhat difficult. The results of the study could suggest that long term azithromycin can be given to many COPD patients, even to those who are not actually frequent exacerbators. The place of azithromycin

88 Oncogenesis, Inflammatory and Parasitic Tropical Diseases of the Lung

in the prevention of COPD exacerbations is a topic which needs further research.

Giving long term antibiotic treatment to a patient may have consequences; the development of antimicrobial resistance is by far the most important one. Several researches have shown that the erm(B) and mef genes are mostly responsible for macrolide resistance in streptococci bacteria [139-142]. This resistance can develop even when short term therapy with macrolides is given [141]. The participants receiving azithromycin in the USA study, where a 1-year therapy was administered, were less likely to be colonized with respiratory pathogens but more likely to become colonized with macrolide resistant pathogens [138]. In the UK study in patients with COPD the researchers found there were no significant changes in resistance of sputum pathogens (*H. influenzae, S. pneumoniae, M. catarrhalis*) after 1 year of daily erythro‐ mycin [137]. In a Dutch study investigating antibiotic treatment before cardiovascular surgery 300 patients were treated with 2 weeks of clarithromycin. A significant rise in macrolide resistance in oropharyngeal flora was observed and this resistance continued to exist for at least 8 weeks [140]. Since macrolide resistance in pneumococci is already a known problem [141, 143, 144] it is of great importance to prevent the development of resistance in other

*7.5.3. Antimicrobial resistance*

microorganisms.

S. Uzun1 , R.S. Djamin1 , H.C. Hoogsteden2 , J.G.J.V. Aerts1,2 and M.M. van der Eerden2

1 Department of Respiratory Medicine, Amphia Ziekenhuis, Breda, The Netherlands

2 Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
