Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study

Am J Respir Crit Care Med. 2003 Jul 1;168(1):121-5. doi: 10.1164/rccm.200212-1424BC. Epub 2003 Apr 2.


Bronchiolitis obliterans syndrome remains the leading cause of morbidity and mortality in the pulmonary transplant population. Previous studies show that macrolide antibiotics may be efficacious in the treatment of panbronchiolitis and cystic fibrosis. In the latter, azithromycin decreases the number of respiratory exacerbations, improves FEV1, and improves quality of life. We hypothesized that oral azithromycin therapy may improve lung function in patients with bronchiolitis obliterans syndrome. To test this hypothesis, we conducted an open-label pilot trial using maintenance azithromycin therapy in six lung transplant recipients (250 mg orally three times per week for a mean of 13.7 weeks). In this study, five of these six individuals demonstrated significant improvement in pulmonary function, as assessed by FEV1, as compared with their baseline values at the start of azithromycin therapy. The mean increase in the percentage of predicted FEV1 values in these individuals was 17.1% (p </= 0.05). In addition, the absolute FEV1 increased by 0.50 L (range -0.18 to 1.36 L). These data suggest a potential role for maintenance macrolide therapy in the treatment of bronchiolitis obliterans syndrome in lung transplant recipients.

Publication types

  • Clinical Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Bacterial Agents / immunology
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / immunology
  • Azithromycin / pharmacology
  • Azithromycin / therapeutic use*
  • Bronchiectasis / surgery
  • Bronchiolitis Obliterans / diagnosis
  • Bronchiolitis Obliterans / drug therapy*
  • Bronchiolitis Obliterans / etiology*
  • Cystic Fibrosis / surgery
  • Drug Administration Schedule
  • Follow-Up Studies
  • Forced Expiratory Volume / drug effects
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lung Transplantation / adverse effects*
  • Middle Aged
  • Pilot Projects
  • Pulmonary Fibrosis / surgery
  • Quality of Life
  • Severity of Illness Index
  • Syndrome
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Immunosuppressive Agents
  • Azithromycin