Bronchiectasis and azithromycin 3 times a week.

@kathyjjb
Just wondering if you have tried the new drug Brinsupri that is supposed to reduce Bronchiectasis flares ? I would be interested to know what your NJH doc thinks about the lower dose Azithromycin and resistance.

I started Brinsupri on 9/21 and will be stopping. It has not helped me. Neither has Ohtuvavre or Dupixent.

@cwal Unfortunately, I have a Medicare advantage health plan and it does not cover Brinsupri. I was misled by my insurance broker and now it's too later to change to the original Medicare plus a gap-at least according to my new health insurance broker. I also cannot get Nuzyra (can't afford the $30,000/month), despite the fact that it shows to be highly effective on MABC.

I will post it when I learn more. I did recently read that Erythromycin is the recommended macrolide for BE inflammation, and it does not cause resistance to MAC, not sure about MABC.

@kathyjjb
I also have a Medicare Advantage plan and between the insurance and The Assistance Fund I pay nothing -so far. Who knows what will happen in the future due to the craziness going on with health care plans. Have you heard about The Assistance Fund? Many have been able to get the medication this way.

@cwal Yes, I have heard of it, but I don't know much about it. Where did you apply? I may not qualify as I heard the income requirements are very low. That said, I certainly don't have anywhere nears the income to ever pay for these drugs.

@kathyjjb - I don't know anyone who would have the income to afford this medicine. That is what the assistance fund is for.

Here is their contact info and website;
https://tafcares.org/
The Assistance Fund contact info;
Phone: (855) 845-3663
Patient Fax: (833) 789-1228
Business Fax: (855) 430-0590
Monday - Friday, 9 a.m. - 5:30 p.m. ET

Headquarters:
The Assistance Fund
8427 Southpark Circle
Suite 100
Orlando, FL 32819

@rma1949 I've cut and paste from the article "Bronchiectasis — A Clinical Review" from 2022 (from the ABCs of bronchiectasis thread) which describes the use of azithromycin. It can be quite beneficial in those with frequent exacerbations. When I was on it for bronchiectasis I noticed auditory side effects but it's difficult to pin this on that experience as I have been on my share of z-paks in my life. So might have been a cumulative effect.

"For patients with substantial daily symptoms and frequent exacerbations (three or more per year), additional therapies may be required to improve quality of life and prevent further lung damage. In a meta-analysis of three randomized trials, investigators found that the use of macrolide antibiotics reduced the frequency of exacerbations and increased the time until the next exacerbation. Improvements in quality of life were also documented in those trials. The mechanism of action is unclear, although macrolides may inhibit quorum sensing by P. aeruginosa. The usual dosing regimen is azithromycin at a dose of 500 mg three times per week or 250 mg daily. Although the studies were conducted for only 1 year, it seems that macrolides are generally safe and have an acceptable side-effect profile over longer durations. However, caution must be observed when prescribing macrolides, given the risk of resistance and gastrointestinal, cardiac, and auditory side effects. Macrolide monotherapy should not be used when nontuberculous mycobacterial infection is present or has not yet been ruled out."

@rma1949 I've cut and paste from the article "Bronchiectasis — A Clinical Review" from 2022 (from the ABCs of bronchiectasis thread) which describes the use of azithromycin. It can be quite beneficial in those with frequent exacerbations. When I was on it for bronchiectasis I noticed auditory side effects but it's difficult to pin this on that experience as I have been on my share of z-paks in my life. So might have been a cumulative effect.

"For patients with substantial daily symptoms and frequent exacerbations (three or more per year), additional therapies may be required to improve quality of life and prevent further lung damage. In a meta-analysis of three randomized trials, investigators found that the use of macrolide antibiotics reduced the frequency of exacerbations and increased the time until the next exacerbation. Improvements in quality of life were also documented in those trials. The mechanism of action is unclear, although macrolides may inhibit quorum sensing by P. aeruginosa. The usual dosing regimen is azithromycin at a dose of 500 mg three times per week or 250 mg daily. Although the studies were conducted for only 1 year, it seems that macrolides are generally safe and have an acceptable side-effect profile over longer durations. However, caution must be observed when prescribing macrolides, given the risk of resistance and gastrointestinal, cardiac, and auditory side effects. Macrolide monotherapy should not be used when nontuberculous mycobacterial infection is present or has not yet been ruled out."