Zithromax prophylaxis (250 mg once daily, 3 consecutive days a week), has been studied to decrease the frequency of annual episodes of respiratory exacerbation in primary immunodeficiency patients with frequent respiratory infections.
Primary antibody deficiencies are considered rare diseases, but only 1% of subjects living with it actually receive a diagnosis. The spectrum of primary antibody diseases include, X-linked agammagloubulinemia and common variable immune deficiency (CVID).
Because of the lack of protective antibodies, the respiratory tract is the is major target for acute infections requiring immunoglobulin replacement therapy and frequent courses of antibiotics. Respiratory exacerbations in patients result in frequent visits to doctors offices and ER, hospitalizations and work days lost. IgG replacement therapy enhances survival and reduces the risk of pneumonia and invasive infections. Despite appropriate therapy, patients can still have chronic infection related pulmonary diseases, including bronchiectasis, COPD and asthma.
Patients with primary immune deficiencies can take advantage of antibiotic prophylaxis. Zithromax (macrolide antibiotics) have proved effective to successfully manage cystic fibrosis, COPD and asthma. In addition to antimicrobial effects, macrolides have immunomodulatory and anti-inflammatory properties, acting on the vicious circle of infection to inflammation that leads to airway hyperreactivity and remodeling.
A most recent study published in the Journal of Allergy and Clinical Immunology, looked at Zithromax prophylaxis in reducing respiratory exacerbation in patients with antibody deficiencies. The principal findings were:
- This double blind, random study showed the efficacy and safety of long-term prophylactic treatment with zithromax in patients with primary antibody deficiencies
- Long term zithromax prophylaxis reduced the need for additional antibiotic courses and risk of hospitalization and improved quality of life.
- Low dose Zithromax did not increase the rate of adverse events or the risk of resistant organisms.
Adding Zithromax prophylaxis to the treatment regimen of patients affected by primary antibody deficiencies with respiratory exacerbations should be considered.