Azithromycin 500 mg. 3 X week for Bronchiectasis

Due to kidney issues I am on only 250 mg 3 x a week. I have no idea if it is helping or not. It's been about 2 months for me. I have pseudomonas but people don't seem to like this treatment because they say it can cause MAC (if you should get it) to become resistant to azithromycin and that would be really bad.

On the NTM Talk podcast, both doctors do not recommend taking just the Azithromycin because of the risk of resistance. They recommend taking two. It maybe Episode 2: What is Bronchiectasis?
https://ntmtalk.buzzsprout.com

@cheryl1954 I'm not sure what you mean by improved quality of life, but with bronchiectasis it is very important to identify the exact bacteria attacking your lungs, and test to see which drugs it will respond to.
This is not typical treatment if you have MAC, because Azithromycin is one of the drugs which needs to be used in combination and for a long time to fight a MAC infection. Using it as a prophylactic causes antibiotic resistant bacteria to take over, potentially making you worse.

Here is my story about Azithromycin about long-term azithromycin. For 3 years I was suffering ever more frequent bouts of bronchitis and pneumonia, constant asthma attacks, severe cough, weight loss and fatigue. Every visit to the doc or ER resulted in an x-ray, diagnosis of bronchitis or pneumonia, advice to neb more and use my rescue inhaler more, 2 weeks of oral prednisone and antibiotics. I would feel better for a few months, or weeks, and the cycle started over.

Finally, a sharp-eyed radiologist noted in the x-ray report "...evidence of bronchiectasis. Consider referral to pulmonology..." Within 2 weeks, I was seen, CT scan done, diagnosed with bronchiectasis with nodules and "pockets" (I now know they were small cavities). Sputum cultures were taken, pseudomonas identified in just over 1 week and over 2 month of antibiotics were started. He also started me on airway clearance and said no more prednisone for the asthma as it would make the infections worse.

Six weeks later, the doctor called and said I also had MAC, and we would begin treating it after the pseudo cleared. Over 18 months of 3 antibiotics, first 3 times a week, and then daily followed. Eventually my lungs looked better, but I still grew MAC in my cultures. The ID doc suspected that the overuse of Azithromycin in prior years made it less effective on my infection, but could not increase the doses any more. The drugs were making me so sick the ID doc stopped them, and a new pulmonologist switched me to 7% nebs (which I learned about on Connect.)

Here come my questions for you:
Are you being treated by a pulmonologist or infectious disease specialist experienced in treating people with bronchiectasis?
Do you have a diagnosis of MAC, Pseudomonas or another infection? Was it done using a culture of your sputum (takes up to 2 months to grow out the slow growing MAC bacteria, less for pseudomonas) or a bronchoscopy?

Sorry for the length of this message, but I wanted you to understand why the MAC experts are so insistent about proper diagnosis & treatment.

Sue

I was told the argument for using azithromycin is that it has anti-inflammatory effects and can also decrease the mucus production and prolong periods of no flairs. I don't have MAC at this point and I am 77 so the ID dr. may not be worried about the resistant MAC situation. Also I have bad kidneys and heart issues which probably wouldn't sustain that 3 antibiotic treatment regime. Who knows. There are studies that show it helps some bronchiectasis issues while those studies admit it can cause resistance. In any case, the az treatment is not an accepted treatment among experts it seems.

Hmm, his recommendation surprises. Azithromycin can affect kidney function and worsen kidney failure (my husband is Stage 3B and they will not prescribe it.) It can also have some effects on the heart, and anyone with heart issues should make sure their cardiologist knows they are taking it.
There are other safer ways to decrease mucus and inflammation, including Singulair, guaifenesin, N-acetyl Cysteine, albuterol/levalbuterol. Airway clearance with nebulized saline and a PEP device can also help.
Only you and your doctor can decide what is best for you, but remember sub-clinical doses of a broad-spectrum antibiotic can also make other bacteria such as staph, strep & e. coli resistant to common antibiotics.
Sue

My cardiologist and very careful kidney dr. signed off on it. I understand the risks but at this point I am not in a position to get into disputes with the doctors since I am overall not very well and at the moment there is some improvement and my kidney function is stable. It's only been a couple of months so the risks are not intolerable for this short period. A discussion will happen in another month no doubt.

I just had a stress test and ekg re the q elongation thing. (I forgot to add)

Taking the Azithromycin 3 times a week is a prophylactic treatment for chronic Pseudomonas. For me it had an anti inflammatory effect and made the mucus very easy to expel. BUT after only taking it for one day i had heart symptoms. So i never took it again. I do not see how people can tolerate it ongoing but some people do just fine on it. I have read that you should NOT take it alone if you have MAC .

Hi Sue,
Thank you so much for your reply. I am being seen by a bronchiectasis specialist at Mass General Hospital in Boston. I do not have MAC, but have had many different infections, pseudomonas aeruginosa. Have not had a bronchoscopy but it's been discussed as a possibility. I have had numerous sputum cultures. I was also told that azithromycin would have anti-inflammatory effects and would decrease mucous production and protect against infections and also improve the lining of the lungs. I also nebulize with 3% saline and albuterol separately and take singular and breo ellipita. I am 68, and not sure if I should be worried about taking this.
Again, I really appreciate your reply.
Cheryl

Cheryl: I take Breo too. I can't use Singular because I have an autoimmune disease and the rheumatologist said that Singular is too risky because it could cause Churg Strauss reaction in me (an autoimmune lung response). Interesting that our specialist doctors seem in agreement on the treatment...I'm trying not to worry.