Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial

JAMA. 2013 Mar 27;309(12):1251-9. doi: 10.1001/jama.2013.1937.


Importance: Macrolide antibiotics have been shown beneficial in cystic fibrosis (CF) and diffuse panbronchiolitis, and earlier findings also suggest a benefit in non-CF bronchiectasis.

Objective: To determine the efficacy of macrolide maintenance treatment for adults with non-CF bronchiectasis.

Design, setting, and participants: The BAT (Bronchiectasis and Long-term Azithromycin Treatment) study, a randomized, double-blind, placebo-controlled trial conducted between April 2008 and September 2010 in 14 hospitals in The Netherlands among 83 outpatients with non-CF bronchiectasis and 3 or more lower respiratory tract infections in the preceding year.

Interventions: Azithromycin (250 mg daily) or placebo for 12 months.

Main outcome measures: Number of infectious exacerbations during 12 months of treatment. Secondary end points included lung function, sputum bacteriology, inflammatory markers, adverse effects, symptom scores, and quality of life.

Results: Forty-three participants (52%) received azithromycin and 40 (48%) received placebo and were included in the modified intention-to-treat analysis. At end of study, the median number of exacerbations in the azithromycin group was 0 (interquartile range [IQR], 0-1), compared with 2 (IQR, 1-3) in the placebo group (P < .001). Thirty-two (80%) placebo-treated vs 20 (46%) azithromycin-treated individuals had at least 1 exacerbation (hazard ratio, 0.29 [95% CI, 0.16-0.51]). In a mixed-model analysis, change in forced expiratory volume in the first second of expiration (percent of predicted) over time differed between groups (F1,78.8 = 4.085, P = .047), with an increase of 1.03% per 3 months in the azithromycin group and a decrease of 0.10% per 3 months in the placebo group. Gastrointestinal adverse effects occurred in 40% of patients in the azithromycin group and in 5% in the placebo group (relative risk, 7.44 [95% CI, 0.97-56.88] for abdominal pain and 8.36 [95% CI, 1.10-63.15] for diarrhea) but without need for discontinuation of study treatment. A macrolide resistance rate of 88% was noted in azithromycin-treated individuals, compared with 26% in the placebo group.

Conclusions and relevance: Among adults with non-CF bronchiectasis, the daily use of azithromycin for 12 months compared with placebo resulted in a lower rate of infectious exacerbations. This could result in better quality of life and might influence survival, although effects on antibiotic resistance need to be considered.

Trial registration: clinicaltrials.gov Identifier: NCT00415350.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / adverse effects
  • Azithromycin / therapeutic use*
  • Bacterial Infections / etiology
  • Bacterial Infections / prevention & control*
  • Biomarkers / blood
  • Bronchiectasis / complications*
  • Double-Blind Method
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Inflammation
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Quality of Life
  • Respiratory Function Tests
  • Respiratory Tract Infections / etiology
  • Respiratory Tract Infections / prevention & control*
  • Sputum / microbiology


  • Anti-Bacterial Agents
  • Biomarkers
  • Azithromycin

Associated data

  • ClinicalTrials.gov/NCT00415350